Lead poisoning remains an important yet under-recognised cause of morbidity in children. We report the case of a two-year-old child presenting with asymptomatic lead poisoning identified following investigation of pica, including ingestion of wall paint. This was with concomitant iron deficiency anaemia secondary to excessive cow’s milk intake. Given these significant risk factors, blood lead level screening was done despite her asymptomatic presentation, revealing a markedly elevated lead level of 3.34 µmol/L (reference range ≤ 0.10 µmol/L). Following these results, she was admitted for treatment with chelation therapy under the guidance of the National Poisons Information Service (NPIS), with ongoing surveillance in clinic to monitor treatment response and ensure a decline in blood lead levels. This case highlights the diagnostic challenges of asymptomatic lead poisoning and emphasises the importance of having a low threshold for screening in children with risk factors, including pica, nutritional deficiencies, and potential environmental lead exposure. Early recognition can facilitate timely treatment, reducing the risk of long-term complications.

Rafia Ayub achieved her MBBS and BSc with Honours at St George’s University of London. She has completed Foundation Training at Manchester University NHS Trust and has 2 publications and multiple impactful quality improvement projects within her portfolio.