American Academy of Pediatrics Council on Environmental Health

View all recommendations from this society

Released May 17, 2021

Do not order “chelation challenge” urinary analyses for children with suspected lead poisoning.

The “chelation challenge” was formerly used to assess whether a child had a significant body burden of lead, or “lead poisoning,” and whether formal chelation would result in significant clearance of lead. Evidence exists that suggests that the chelation challenge has no better prognostic value than the standard blood lead level. Further, there is some evidence that the chelation challenge may in fact be potentially dangerous. In summary, chelation challenge has no clinical utility in the treatment of childhood lead poisoning today

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific
questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists
dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

The American Academy of Pediatrics’ Council on Environmental Health (COEH) consists of pediatricians who have a special interest in children’s exposures to
environmental contaminants and the care of the environment in which we live. COEH strives to inform pediatricians, parents, communities, and policy makers on
environmental issues that can result in harm to children. As a result, the members of the Executive Committee of COEH were queried to provide their scientifically
informed opinions as nationally recognized experts in pediatric environmental health to identify diagnostic and management decisions that have resulted in
patient harm either from a misdiagnosis or inappropriate therapy. These 5 clinical issues are the result. Various expert committees, councils, and sections of the
AAP reviewed and approved the list. The list was approved by the AAP Board of Directors and Executive Committee.

Note: Pediatricians should consult with specialists who are trained in toxicology or environmental health when questions such as these arise. The American
Academy of Pediatrics has partnered with the American College of Medical Toxicology (ACMT) to co-administer the Pediatric Environmental Health Specialty
Units (PEHSU), a network of pediatricians and medical toxicologists serving individual federal regions to help with education and consultation of children with
environmental exposures. PEHSUs are funded by the US Department of Health and Human Services Agency for Toxic Substances and Disease Registry and the
US Environmental Protection Agency with a cooperative agreement with AAP and ACMT. Visit:


American College of Medical Toxicology. Position statement on post-chelator challenge urinary metal testing. J Med Toxicol. 2010;6(1):74-75

Ruha AM. Recommendations for provoked challenge urine testing. J Med Toxicol. 2013;9(4):318-325

Soden SE, Lowry J, Garrison C, Wasserman G. 24-Hour provoked urine excretion test for heavy metals in children with autism and typically developing controls: a pilot study. Clin Toxicol.