Health Effects of Childhood Lead Poisoning
And now we are hearing about imported toys through the media. Is this a scare? Is it true? How do we know? We must assume that it is true. The really alarming information is that this may have gone on for years. How do you find safe, quality toys, that are develpmentally stimulating for your children, and not just hazourdous piles of junk?
Environmental Health Hazards
Since 1950, more than 65,000 NEW chemical compounds have been introduced into common use in the western world. 84% have NOT been tested for toxicity.
Superfund sites are hazardous waste sites designated by the EPA to be a threat to human health; these may include leaking underground storage tanks or hazardous waste sites such as municipal dumps and contaminated factories or mines and mills (Chiras, 1994, p. 462nds, )More than 40 million people live within 4 miles of a Superfund site. Approximately 4 million people live within 1 mile of a Superfund site. Lead very likely will be found in superfund sites.
Environmental Hazards of concern fall into four widely accepted classes
CHEMICAL
PHYSICAL
BIOLOGICAL
PSYCHOSOCIAL
Environmental Health Hazards
In the Home
MOLD
DUST
LEAD
Environmental Health Hazards
What is Lead?
One of the 102 elements (Are there more now? Ii have lost track) from the periodic table
A metal that is naturally found in mineral deposits.
A very stable metal that does not decay for millions of years.
Has been used in numerous products because of its malleability, low melting point, and ability to form compounds (paint, glazes, solder, to name a few)
Historical Uses of Lead
Romans: Used lead as a sweetener; Egyptians: Used lead as a cosmetic; Industry: paint, gasoline, glazes, colored newsprint
Sources of Lead Exposure in the Environment
Lead based paint and soil,oil and dust near lead industries, roadways, railroad tracks, coating the hulls of ships. Homes built before 1978. Imported cosmetics: Indian Surma, Arabic Kohl, Burmese Thanaka. Home Remedies: Azarcon, Greta. Vinyl miniblinds. Imported candies (Mexican tamarind in pots)Imported pottery.  There is lead in some cosmetics, including some “designer” lipsticks.
Other “products” containing lead:
Window blinds. Painted furniture, Leaded crystal glassware and dishes, Â Bullets, Keys. Exposure to the remants of war, in water wells, and in the soil, in other countries, though we don’t know about what is here, other than the superfunds.
Sources of Lead Exposure
Hobbies and related activities- Glazed pottery making, glass blowing.
Target shooting at firing ranges, Lead soldering (e.g. electronics)Painting, Preparing lead shot, fishing sinkers, Stained glass making, Home remodeling, Car and boat repair. Cometics, some lipsticks
Sources of Lead Exposure
Occupational
Plumbers, Lead miners, Auto mechanics
Repair of radiators, in particular
Bridge, tunnel, and elevated highway construction
Today…
…Lead-based paint is the single most common source of lead poisoning during childhood.
Routes of Absorption
Ingestion
the most common route for children
Inhalation
not a common route for children
Transplacentally (In Utero) to the developing fetus
Why is lead a problem?
Lead is a neurotoxin that causes serious health problems especially for young children:
Brain damage, growth delays, learning disabilities, other serious health problems
Who is at risk?
Children under the age of 6 years
the brain is still rapidly  developing; high hand-to-mouth activity and they “live” closer to the ground
increased exposure to dust and soil, Â increased exposure to carpets: a reservoir for many contaminants
Higher rate of metabolism/absorption than adults
Who is at risk?
Children with certain risk factors
iron deficiency anemia
pica
Children from low-income households (environmental and social justice concerns)because they often live in old run down homes in the poor side of town.
Children with poor nutrition
But in addition, ALL families refurbishing older homes and unaware of the risks to their children
Recent immigrants
How Do We Identify Children with Lead Poisoning?
Lead poisoned child may not look or act sick.Lead poisoning has no symptoms (problems show up later on in school, when it may too late to correct the problem or gain lost educational time). The only way to know is to look for lead poisoning  with a blood lead screening test
Health Effects of Lead Poisoning
(particularly in children)
Learning disabilities, Behavioral problems, slowed physical growth, systemic effects on kidneys and blood forming organs
BLOOD LEAD SCREENING:
WHO & WHEN?
Blood lead screening should be required for:Â Any child at risk for lead poisoning.(When:-Ages 12 and 24 months, or as needed-Any time 12-72 months if not tested before-Any time 12-72 months if change in risk for lead poisoning
Blood Lead Screening @ 12 & 24 months: WHY?
Prevents lead poisoning: identifies child with low level; family education prevents blood lead level (BLL) rising to higher/poisoning levels
Why aren’t high-risk children being screened for lead poisoning?
Not ordered by primary care physician, uninsured children not getting comprehensive health care, parents unaware to act as their own advocates, and some providers just don’t believe in neurotoxins in our environment (“we don’t have a problem where we live”).
What is lead poisoning in children? Markowitz definition
“…a disorder characterized by subclinical and biochemical finding in largely asymptomatic children.” (Markowitz. 2000. Lead poisoning. Pediatrics in Review. 21(10): 327-335.
Centers for Disease Control definition
A blood lead level as “low as 10 mcg/dL … associated with harmful effects on children’s learning and behavior.”
How much is a µg/dL (microgram/deciliter) ?
Microgram: A penny weighs about 2 grams. Imagine cutting a penny into 2 million pieces. One microgram would weigh the same as 1 of those 2 million pieces.Deciliter: A deciliter is equal to about ½ cup. Or, you’d get 1µg/dL concentration if you flooded a football field with 2 feet of water and added 1 tablespoon of sugar Message: It takes only a small amount of lead to cause a lot of harm.
There is No Safe Blood Lead Level
IQ score decreases 1/4-1/2 point for every 1 µg/dL rise in Blood Lead Level:
BLL of 4 µg/dL = loss of 1 IQ pointBLL of 12 µg/dL = loss of 3 IQ pointsBLL of 16 µg/dL = loss of 4 IQ pointsBLL of 20 µg/dL = loss of 5 IQ pointsBLL of 28 µg/dL = loss of 7 IQ pointsBLL of 32 µg/dL = loss of 8 IQ pointsBLL of 40 µg/dL = loss of 10 IQ points
Society Impact of an Average Decrease of 4 IQ Points:
50 % less children with IQ > 125Twice the expected number of children with IQ < 80
How Do We Treat Lead Poisoning?
Health Services: Identify elevated blood lead level (EBLL); case management of child/family until resolved (average = 1/1/2 yrs)Environmental Services: Identify lead hazards in the home. Housing Services: Remove lead hazards in the home
Lead Poisoning Case Management
Lead poisoning educationIdentification of lead sourceNutrition educationStrategies to minimize lead exposurePlan of careAssess other health/social concernsReferral for Public Health Investigation or Environmental Investigation through local health departmentTreatment
Remove sources of leadChelation EBLL > 45 µg/dL
Strategies for Reducing Lead Exposure
Frequent hand washingWash toys oftenWet mop floorsWet wipe window sillsWipe your feet outside or take shoes off before entry
Strategies for Reducing Lead Exposure
Frequent vacuuming with a HEPA vacuum cleanerIncreasing dietary intake of iron and calcium (but not in the same meal because iron and calcium compete for absorption by the body.Frequent mealsTake iron with vitamin CRun cold water through the pipes for a few minutes before using water
Lead Poisoning
Case Management
Environmental Services
Environmental Investigation of home by registered environmental health specialistChild focusedTesting procedure
XRF-real time resultscollected samples sent to certified lab for analysis.
Lead Poisoning
Case Management (who would do the case management?)
Housing Services
Review Environmental Investigation results with families/ownersDesign plan for remediation in conjunction with the ownercheck to see if financial assistance is available for remediation by the local public housing departmentReferral to enforcement as needed
There is a national model of combined services under one umbrella (Health, Housing, Environmental though it may not be available where you live)
So back to the “superfund”. we are all at risk. where do we think we are dumping industrial toxic wastes, and what are we dumping: computer equipment, cell phones, batteries. Close to your back yard. We are all at risk.
Factor in here the combination of environmental justice and social justice, not to mention health care justice which we surely do not have in this country right now. What part of our population do you think is most susceptible to lead poisoning? And why?
If you are concerned about childhood lead poisoning, ask you child’s pediatrician, nurse practioner, physician assistant, or nurse. Don’t accept an answer “Oh; don’t worry, Mommy” Tell the provider that you want the simple blood test ordered (a fingerstick) Â if you feel that your child is at risk. And don’t stop there. Call your local health department (public health nursing, environmental health, or housing offices).
The last word: yes you can buy lead testing kits at your local hardware store. But they have been proven to be innacurate. The only way to be sure about your child’s blood lead level is to ask your health care provider for a blood lead test for your child.
 I realize that I have referred to pets in my blog before. But I feel that this is important since we live pretty intimately with our pets. Yes; they can be have lead poisoning as well, depending on their environment. If you are concerned about neurological dysfunction in a pet, do ask your veterinarian to test your pet.
 And please do not take “no need” as an answer from your pediatrician or vetrinarian.