Letter to the Editor

issue of Paediatrics & Child Health (1), that no child was poisoned by jewellery between 1997 and 2006 at CHU Sainte-Justine in Montreal, Quebec, should not engender complacency.In the United States, one child was sickened in 2004 and one child died in 2006 following ingestion of lead-containing baubles (2).Indeed, objects other than dense metal items (eg, jewellery, lead shot and fishing weights) may also be problematic.Paint on toys and beads, as well as ceramics and vinyl products may contain 'migratable' lead that could dissolve or be rubbed or sucked off (2).Health Canada has issued numerous consumer alerts regarding lead-containing jewellery but, recently, manufacturers have substituted another metal that is dense, inexpensive and even more toxic -cadmium (3).As indications of relative toxicity, Canadian drinking water standards are 5 µg/L for cadmium and 10 µg/L for lead (4), while Ontario's Ambient Air Quality Criteria from 2008 (5) suggest even greater toxicity differences, with 24 h thresholds of 0.025 µg/m 3 for cadmium and 0.5 µg/m 3 for lead.Variations in relative levels reflect that fine particles infiltrating the lowest reaches of the lungs are absorbed efficiently, while intestinal absorption is more limited, albeit greater in children and individuals with poor nutritional status (6).On December 1, 2010, a revised Consumer Product Safety Act gave Health Canada the authority to require analytical data from manufacturers and importers, and to halt manufacture and trade of potentially harmful goods.Unfortunately, sporadic sources of toxins are too often discovered only once a child has been poisoned, and so caregivers remain at the front line of prevention.They must be cautious to ensure that least-toxic, ageappropriate items are provided to young children (2).Besides low-cost jewellery and toys (particularly from China), other common sources of lead in children's environments are leaded paint chips or dust; drinking water (from lead in pipes, solder and fittings); plastic products; food that was grown in contaminated soil, shot with lead ammunition, or stored or served in leaded glassware, pewter or pottery; cosmetics; ethnic remedies; and activities such as restoration of buildings or furniture, automobile bodywork, welding, painting, making stained glass and ceramics, and marksmanship with lead ammunition.Inexpensive imported foods, including candies, have also been contaminated (2).Cadmium may accompany lead contamination.Apart from mining and industry, a few other sources of cadmium include cigarette smoke; nickel-cadmium batteries; various metal and plastic consumer products; and foods such as oysters, organ meats, and some crops including seeds (grains and nuts) and brassicas, particularly when grown in cadmium-rich soil.Canada

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