Over the years, recommendations for acceptable amounts of lead in children’s blood has fallen lower and lower; in fact, researchers now posit that no amount of lead may be safe.
In this second of two parts, we examine what happens when a child has been exposed to lead.
By Whitney Isenhower
Since discovering that their home had exposed their young son to lead, Stephanie Jones and her husband have taken several measures. They’ve continued taking their son to pediatric appointments to test his lead levels, had inspectors check their home for sources of lead exposure and looked into companies that can clean their home to remove the lead.
“It’s been so stressful,” Jones said. “You feel paralyzed as to what you want to do next.”
The couple bought their home, built in 1922, five years ago, without realizing a home built before 1978 had a greater chance of containing lead.
Jones and her husband learned from inspectors that lead could be present in wooden panels framing windows by the front door that their son likely had chewed, and that lead dust had possibly transferred to the house from old wood that her husband used to make pictures frames in his basement woodwork studio.
Jones learned her son had lead in his blood after taking him for a routine pediatric appointment in February 2013. He had a level of six micrograms of lead per deciliter of blood (µg/dL). His level jumped to as high as 10.4 µg/dL in September, but was down to 3.6 µg/dL in December.
No level may be safe
Though the level at which the state classifies blood lead as being elevated was lowered from 10 to five µg/dL, a level as low as 20 is considered poisoning. Treatment and follow-up approaches also are tailored to the level of lead detected in the child’s blood. The new classification follows a Centers for Disease Control and Prevention recommendation.
Rebecca Rice, a community-health educator in environmental health at the Guilford County Health Department, said if a child her department tests is found to have a level of five to nine, they’ll educate the family and give information about how nutrition, primarily increasing calcium intake, can help eliminate lead from the body.
The agency also does follow-up tests every three months for children who have two consecutive tests at that level. If a child’s level is 10-19, the county intervenes to try to determine the source of the lead. If a child’s level is higher than 20, they take action to get the child medical attention, as a level this high could lead to learning disabilities.
Aside from emergency cases – such as recommended hospitalization if the level is 70 or above – changing diet and limiting, ideally eliminating, lead exposure are primary strategies in treating children with lead in their systems.
“Nutrition is the biggest way to get the lead levels down,” Rice said.
Chelation therapy is also a possible treatment, sometimes carried out when a child has levels of 45 or above. It involves injecting a chemical into the body that binds to lead to help remove it.
But chelation can have harsh effects. And its effectiveness in removing lead in levels under 45 is unproven, according to David Eldridge, an associate professor in pediatrics at East Carolina University, who also is board certified in both pediatrics and medical toxicology.
“Chelation doesn’t seem to be a magic bullet for lead poisoning,” he said. He also advised that any physician considering this treatment should consult with a doctor who is proficient in performing it.
Eldridge said if the lead is visible on an X-ray and detected to be in the stomach, it’s important to remove it quickly. Given that the stomach is acidic, lead can leach out into the body, he said. Either giving a child substances that can flush the lead out of his or her system or performing an endoscopy – a procedure that inserts a tube inside the body – could be taken at that point.
Eldridge also said that children’s changing levels, such as with Jones’ son, can occur as lead moves from the blood to potentially build up in the bones, and can then move back to the blood. He said as lead leaves the bones, it could keep the levels elevated for some time, potentially months or years.
Though negative effects on children’s development and the possibility of brain damage increase as blood lead levels get higher, it’s possible no lead level is really safe for a child.
“Any lead exposure probably has some detrimental effect,” Eldridge said.
Testing
According to current screening recommendations, all children on Medicaid should have a blood test for lead when they are 12 and 24 months old, or if they are 36 to 72 months old and have not been tested before. The recommendation focuses on children on Medicaid because they are considered to be at higher risk of exposure of living in older homes where lead is possibly present.
Eldridge said that at the ECU department of pediatrics clinic where he works, the staff follows those same testing standards for all children, regardless of their Medicaid status.
Ed Norman, program manager in the Environmental Health Section of the state Department of Health and Human Services (DHHS) Division of Public Health, said North Carolina is primarily meeting the Medicaid screening requirement.
DHHS data show that 80.7 percent of children on Medicaid who are between the ages of 9 months and 35 months were tested in 2011 throughout the state. This figure is up from 41.4 percent tested in that same age category in 1998.
Jones does not fall under the Medicaid recommendation. She also does not recall if the physician who screened her son did it as a routine procedure or identified him as high risk from living in an older home.
Sources of lead
Apart from homes built before 1978 – which are an issue because of the higher possibility of lead-based paint having been used – toys, keys and vinyl mini-blinds (especially a concern in the mid-1990s) can present possible lead exposure. If paint is peeling, it presents a greater risk, and steps to remove or conceal it so it can’t cause exposure should be taken quickly.
Linda Block is a certified lead risk assessor in Asheville and director of the former Healthy Homes and Lead Safety program. She inspected the Jones’ home after they discovered their son could have been exposed to lead in it.
Block echoed Eldridge in saying that any amount of lead could be an issue in children.
“It’s not really a concern just about children who are poisoned,” she said. “It’s a concern about children who have any detectable level of lead in their blood.”
Homemade pottery, brass figurines and even wristwatches can carry lead.
Assessing the risk
Jones now considers herself significantly more knowledgeable about lead and the effects it can have on children. After finding out her son had lead in his system last year, she talked with Block about lead exposure and the steps she could take. She also did online research.
When revisiting the topic for this story, she also checked to see if she had signed anything when she bought her house that could have warned her about lead in her home.
It turns out, she had. In the paperwork from her closing, there was a “Lead-based Paint or Lead-based Paint Hazard Addendum” form.
“Even with that, it’s like, ‘It’s not going to be an issue,’” Jones said.
The document does have an asterisk: “*Intact lead-based paint that is in good condition is not necessarily a hazard.”
“After seeing this, I don’t know that we would have done anything different,” she said. “Unless somebody said, ‘Listen, you’re going to buy a house and if your child eats lead paint, bad things are going to happen.’”
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