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Lead poisoning has direct effects on your child’s kidneys, blood, bones and brain. Because a child’s brain is still developing, the effects are especially serious and potentially permanent. Lead can also affect the unborn fetus in exposed pregnant mothers. Lead poisoning has been linked to developmental delays, speech problems, behavior problems, and aggression.
Recently in the news, we heard about the crisis in Flint, Michigan, where a change in the public water supply exposed the community to toxic levels of lead and other compounds. The number of children with lead poisoning doubled. Here in the Jacksonville area, we still frequently deal with cases of elevated lead levels due to various environmental exposures. So where is the lead coming from, and how do you know if your child is at risk?
Most lead poisoning is due to chronic, repeated exposure to this toxin. The dangers have been known for thousands of years, and even the fall of the Roman Empire is thought to be partly due to the brain and health effects of ingested lead. The Romans drank from lead urns, used lead in cosmetics, and had lead plumbing systems. The lead sources in the United States are largely due to lead in paint and gasoline, as well as lead in imported products used by our children. The addition of lead to household paint was not banned until 1970 and fully removed until 1978. The lead in gasoline was not regulated and reduced until 1973. And in 1991, the CDC finally created a plan to detect and fight the problem.
Risk factors in the U.S. include:
Children who live in or regularly visit homes built before 1978
Children in homes built before 1978 with recent remodeling
Children who live with someone who has a job or a hobby that may involve lead, such as
building renovation or repair, plumbing, or working with automobile batteries or radiators.
Children who live near a lead smelter or paint factory
Children living in a designated high risk area (mostly urban)
So how does the lead get into our system? Old water pipes may have lead, mainly from lead soldering, that gets into drinking water. For older homes with leaded paint, the lead can be in the dust that settles in your house and in the dirt that surrounds your house. Remodeling can actually increase the exposure for a period of time. Not only do children get this dirt and dust on their hands and then in their mouths, but also their bodies absorb it much easier than adults. Other sources include some vinyl mini blinds, some imported toys, food stored in glazed ceramics, and some folk remedies, such as greta and azarcon, which are used by some to treat an upset stomach.
How can you tell if your child has been exposed? Since most lead poisoning is chronic exposure, there are no obvious symptoms. For this reason, the American Academy of Pediatrics recommends screening with a questionnaire from age 6 months to 6 years and testing those found to have risk factors. Most doctors will test all children at age 12 months and 24 months, although some do not test if there are no risk factors. Still, a published study in 2013 showed that the questionnaire may not be a good tool to decide who to test. Keep in mind that blood samples taken from your child’s finger may be contaminated and therefore require a confirmatory blood test from the arm.
Acute lead poisoning, which is rare, may present with pain and weakness, difficulty concentrating, irritability, anemia, abdominal pain, and weight loss. Even with early treatment, chronic lead poisoning effects are likely.
If your child’s blood level is less than 5 micrograms/deciliter, effects are unlikely. From 5 to 10 mcg/dL, mild cognitive effects have been found. Levels above 10, which is considered toxic, leads to progressive and possibly permanent effects on the brain and body. Toxic levels need to be monitored periodically by your pediatrician and reported to the health department if very high.
How is lead poisoning treated, and how do I prevent it?
Severe acute lead poisoning is treated in the hospital with chelation, a treatment that removes it from the body. But this treatment is uncommonly needed. The mainstay of treatment is identification of those at risk of chronic poisoning and reducing exposure:
If you are concerned about lead in your water, commercial testing kits are available at home improvement stores for about $10.
Fortunately, nationwide efforts have reduced the prevalence of lead in our environment. In Florida in 1997, there were 2347 cases of childhood lead poisoning, and in 2012 there were only 306, but still there were 3334 children with mildly elevated lead levels (5-9 mcg/dL), so sources of lead are still common. With continued surveillance, routine testing, and reduction in environmental exposures, we can continue to eliminate this threat to our children. For more information, visit http://www.cdc.gov/nceh/lead/ or http://www.floridahealth.gov/environmental-health/lead-poisoning/index.html.
By: Andrew Sinder, MD, FAAP
Jacksonville Pediatric Associates