The case of a child who suffered lead poisoning after swallowing a toy pendant should serve as a warning that the toxic metal can be present in unsuspected sources, according to Oregon health officials.

In the October issue of Pediatrics, the researchers describe the case of a 4-year-old boy in Oregon who became seriously ill after swallowing the medallion from a toy necklace bought at a vending machine.

After it was removed from the boy’s stomach, the medallion was found to be 39 percent lead. The case eventually led the distributor of the jewelry to voluntarily recall more than 1.4 million necklaces.

Although the culprit toys in this case were removed from the market, the incident should alert parents and doctors to the fact that lead can be found in “unsuspected objects,” according to Dr. Jessica L. VanArsdale, of the Oregon Health and Science University in Portland, and her colleagues at the state’s health department.

“All children who ingest metallic foreign bodies should undergo blood lead level testing, with frequent monitoring,” the researchers write.

Moreover, they advise that doctors consider the possibility of lead poisoning whenever a child has unexplained anemia or stomach symptoms that do not follow the usual course. Lead poisoning in children can have long-term effects on behavior, learning and growth.

In this case, the swallowed pendant was not removed until roughly three weeks had gone by. During that time, the child suffered stomach cramps, vomiting and diarrhea that were at first attributed to a virus. When he was later brought to the hospital with worsening symptoms, weight loss and anemia - a deficiency in red blood cells - an X-ray showed that a metallic object was in his abdomen.

Still, doctors thought the object would pass on its own. It wasn’t until the child suffered a suspected seizure that his blood lead level was checked, revealing a lead concentration 12 times higher than the designated “level of concern.”

After the medallion was removed and tested for lead, two similar pendants purchased from Oregon vending machines were analyzed and found to have equally high lead levels. State health officials notified the U.S. Consumer Product Safety Commission (CPSC), and the necklace distributor issued a voluntary national recall.

The U.S.-based company said the necklaces were manufactured in India.

“The recall that resulted from the reporting of this case,” VanArsdale and her colleagues note, “likely protected other children from exposure to this lead source.”

In July, the CPSC announced that the distributor in this case and three other toy-jewelry importers were recalling 150 million vending-machine necklaces, bracelets and rings manufactured in India over concerns about the potential for lead poisoning.

SOURCE: Pediatrics, October 2004.