Understanding Lead Poisoning\ While Progress Has Been Made, a Serious Health Issue Remains

For many pediatricians, the popular expression ’get the lead out’ takes on an entirely different meaning.

As a pediatrician who sees young patients for lead poisoning at Baystate Children’s Hospital’s Pediatric Environmental Health Clinic, the phrase serves as a reminder of the need to protect our children from the devastating health effects of lead exposure. While lead is also toxic to adults, those at greatest risk are unborn babies and young children. Their smaller, growing bodies make them more susceptible to absorbing lead through their gastrointestinal tract, and their developing brains are also highly vulnerable. The effects of lead poisoning are often permanent and irreversible, resulting in damage to the nervous system and kidneys, learning and behavioral problems, slow mental development (including speech and language problems), and even seizures and death in extreme cases of high lead levels.

While we have seen the removal of lead from paint by law (it was banned in 1978), water pipes, gasoline, and other sources still pose risks to children and adults alike; hundreds of young children continue to be poisoned by lead each year in Massachusetts.

At the national level, the Centers for Disease Control and Prevention (CDC) report that there are nearly 250,000 children living in this country with blood-lead levels high enough to significantly put their health at risk. They cite lead-based paint and lead-contaminated dust found in substandard housing where deteriorating older buildings are a major source of lead exposure for children.

However, there are additional risks to lead exposure, such as imported toys and folk remedies, items such as clay pots, and some consumer products, including candies, makeup, and jewelry.

Massachusetts has the highest percentage of homes with lead in the country — nearly 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} — because of the high number of older homes, many in poor shape with peeling paint. Locally, the highest numbers can be seen in Springfield, Holyoke, Westfield, West Springfield, and Chicopee. Because of the high risk in Massachusetts, the state also has the strictest screening rate and a lead law that protects every child’s right to live in a lead-free home.

The law requires the removal or covering of lead-paint hazards — loose lead paint and lead paint on windows and other surfaces accessible to children — in homes built before 1978 where any child under 6 lives. Owners are responsible for complying with the law, including owners of rental property, as well as owners living in their own single-family home.

Lead poisoning is not easy to detect, and children don’t often exhibit any of the subtle signs or symptoms of lead poisoning, making screening — a simple blood test — of paramount importance. As a result, Massachusetts enacted the Lead Poisoning Prevention and Control Act, which requires blood tests for all children up to the age of 3, or until age 4 for those in high-risk communities and up to age 6 for a child entering kindergarten who has never been screened. For those children at high risk, living in housing built before 1978 with peeling or chipping paint or where renovations are taking place, or who have a sibling with an elevated blood lead level, they should be checked every six months.

To further protect our children, on May 16 the CDC adopted recommendations made by its advisory panel of experts that lower the threshold for lead poisoning in children younger than six years of age. Until now, children undergoing a blood test to detect lead poisoning were considered to have a blood-lead level of ’concern’ if the test result was 10 or more micrograms per deciliter of lead in their blood. The new standard — implemented as a result of a growing number of scientific studies identifying that even low blood-lead levels can have lifelong health consequences for children — means the level of concern will now be defined as five or more micrograms of lead per deciliter of blood.

The new classification, which will result in greater monitoring of those patients with elevated blood-lead levels and allow providers to take action much sooner to reduce a child’s exposure to lead, comes as a welcome change among the medical community, whose goal is to prevent elevated blood-lead levels from reaching the point where treatment is needed.

Chelation therapy, a treatment which involves taking a medication that binds with the lead and excretes it from the body, is used for patients whose test results are greater than or equal to 45 micrograms per deciliter of lead in the blood. Because therapy comes with risk, our first step is to work with parents to identify the source of lead exposure and permanently remove it from the home. Chelation is also used when separation from environmental factors does not result in lowering blood levels to an acceptable range.

Physicians worry less about children and lead exposure after the age of 6, as well as exposure for adults, since they have less hand-to-mouth contact from crawling around on the floor and getting lead dust on their hands or putting toys with lead dust on them into their mouths. Also, while statistics show that most children exposed to lead come from families who are poor, lead exposure is not limited to those in the low-income category.

Indeed, many young urban professionals who live in upper-middle-class or upper-class neighborhoods today, who often prefer to purchase and renovate older homes, can increase their family’s risk of lead poisoning when scraping or sandblasting. For that reason, renovation activities should be performed by a certified EPA-approved professional trained to follow lead-safe work practices.

Preventing lead exposure before it occurs is the simplest and most important step you can take to safeguard the health of your family. Before you purchase an older home, get it tested by asking for a lead inspection. Those who rent should ask their landlord to test their home for lead. If he or she refuses, you should call the Childhood Lead Poisoning Prevention Program (CLPPP), under the auspices of the Mass. Dept. of Public Health, which can send a state inspector to your home for free.

The CLPPP also suggests the following tips to protect your child until the lead is removed from your home:

• Wet wipe often, at least once a week, around windows, play areas, and floors to reduce lead dust. Do not use a vacuum or broom to remove lead paint or dust, which can spread the hazardous particles into the air;
• Wash your child’s hands often and always before eating and sleeping;
• Clean toys with soap and water; and
• If a family member works with lead, they should change their clothes before coming home, then take a shower before playing with children. Work clothes should be washed separately from the rest of the laundry. Also, shoes should be removed before entering the home to avoid tracking in lead from the soil, and a doormat should be used to wipe feet.

While the CDC is committed in principle to the Advisory Committee on Childhood Lead Poisoning Prevention’s recommendations, it also stated in its May announcement that it does not have the budget — which went from about $30 million to an astounding low of $2 million this fiscal year — to fund these recommendations. This loss of funding is also felt at the local and state levels, where public health departments have seen a reduction in grants from the CDC to fund their own lead-exposure-prevention programs. As a result, on the same day the announcement was made, the American Academy of Pediatrics called on Congress to reinstate critical funding for lead-prevention programs at the CDC.

Baystate’s Pediatric Environmental Health Clinic offers consulting services for parents whose children are lead poisoned or who have other potential environmental health exposures or illnesses. Services include assessment of environmental exposures, education and counseling on ways to prevent further environmental exposures, and treatment for lead poisoning.

For more information concerning de-leading and what work may be done by an owner or agent, as well as how to become trained in the removal or covering of lead hazards, call the Massachusetts Childhood Lead Poisoning Prevention Program at (800) 532-9571. Also, for more information on the Pediatric Environmental Clinic at Baystate Children’s Hospital, call (413) 794-0904.

Dr. Hilary Branch, a pediatrician at Baystate High Street Health Center – Pediatrics, oversees the Pediatric Environmental Health Clinic at Baystate Children’s Hospital. She serves on the Governor’s Advisory Committee on Lead Poisoning.