Young black girl with braided hair is getting a drink from a school water fountain.
Water fountains located in child care facilities and public schools are one of the primary locations to test for elevated lead levels. Credit: CDC/Amanda Mills

By Will Atwater

It is all too common to find lead in tap water at North Carolina child care facilities, according to a new study by researchers from RTI International

The study, a collaboration between RTI and the Division of Public Health of the state Department of Health and Human Services, included more than 4,000 child care facilities from across the state. It’s the largest peer-reviewed data set of its kind in the U.S., according to Jennifer Hoponick Redmon, director of Environmental Health and Water Quality at RTI.

“From June 2020 through Sept. 30, 2021, we tested every licensed and operating child care center in the state for lead,” Hoponick Redmon said.

Hoponick Redmon also said that the current study, which was funded by the Environmental Protection Agency, was borne out of a 2017 pilot study that tested for elevated lead levels in tap water in a smaller sample size of child care centers and Head Start programs. Among other things, that initial study revealed elevated lead levels in tap water, warranting a larger study. It also demonstrated that large-scale testing could be conducted in an economically feasible way.

The current study, published Sept. 22 in The American Journal of Public Health, revealed that 56 percent of facilities tested had at least one tap with lead levels exceeding 1 part per billion (ppb), which is the reference level set by the American Academy of Pediatrics. 

Furthermore, 12 percent of the centers had “at least one tap with levels exceeding North Carolina’s hazard level of 10 ppb,” according to the report.

“In early childhood, even low-level lead exposures can result in irreversible developmental deficits, IQ loss, and behavioral issues,” Hoponick Redmon said in the RTI press release. “Although plans to modernize America’s aging water infrastructure are in progress, it is critical that we take actionable steps today to prevent childhood exposure to lead. Our findings show that we still need to do more to eliminate water-related lead risks across North Carolina.”

Lead is a neurotoxin that, after entering the bloodstream, migrates to the brain, liver and kidneys, before settling in the bones and teeth, where it accumulates over time. Additionally, studies show that it is particularly harmful to young children and developing fetuses, as it can leach from a mother’s bones and enter the bloodstream during pregnancy. 

Where once scientists believed that people could be exposed to lead without many consequences, the emerging scientific consensus reached over the past few decades is that there is actually no acceptable threshold for lead levels in the body.

The study follows Gov. Roy Cooper’s administration’s 2021 proposed budget that called for allocating $160 million from American Rescue Plan funds to mitigate asbestos, lead paint and lead in drinking water from the state’s public schools and childcare centers.

High-risk environments 

Cary-based pediatrician Brian Bowman said it’s a long and sometimes challenging process to get lead out of the bodies of children as young as a year old who’ve been exposed. 

“These aren’t just little finger prick blood tests that they’re getting – depending on their levels – every two to six months, maybe for years,” he said about the treatment regimen. Resolving the problem can take that long, even if lead has already been removed from the child’s environment.

Child care facilities that rely on well water, facilities located in buildings built before 1988 and ones that are a part of Head Start, a federally funded program that’s free to low-resourced families, have a higher risk of elevated lead levels in their tap water, according to the report.

In the case of well water, the responsibility for monitoring, testing and mitigation falls squarely on the shoulders of individual property owners, whereas facilities that receive water from a municipal source are not responsible for system maintenance. Meanwhile, child care facilities that operate out of older buildings and Head Start Centers may not have the funds necessary to upgrade water lines and tap water fixtures, which are more than likely the point sources for elevated lead readings, Hoponick Redmon said. 

“Testing is the first step to identifying lead exposure risks,” said Riley Mulhern, a research environmental engineer at RTI. “Child care facilities should use cold tap water for formula preparation, designate lead-free taps for drinking and cooking, regularly flush water, install and maintain filters that are certified to remove lead, and replace faucet fixtures.”

Hoponick Redmon said one of the things that surprises people from the study is how lead levels can vary “from tap to tap” in the same facility. She also said another surprise for people is learning that even new plumbing can have elevated lead levels.

“They’ll say, ‘Well, I don’t think I have a lead service line, so I’m fine,’” she said. “But actually, there’s allowable levels of lead, even in new plumbing. So just because you don’t have a lead service line doesn’t mean you don’t have detectable lead at the tap. And sometimes it’s more than just slight detections, it’s to the degree that it’s very elevated. If it were your child [at risk], you would want that checked out and fixed.”

A new house, for instance, with all new plumbing and fixtures may still be at risk of lead contamination if the dwelling is connected to a municipal water supply that has aging copper and lead pipes.

“New houses in old cities can still be problematic,” said Hoponick Redmon.

From testing to remediation

According to the report, buildings in the state with most of the child care facilities were built before the 2014 Reduction in Drinking Water Act was established. The act set the allowable limit for lead plumbing products contained in water fountains, for instance, at 0.25 percent. Also, the report states that “almost half of all facilities were…built before 1988, when the 1986 amendments to the Safe Drinking Water Act first restricted the allowable amount of lead in plumbing to 8.0 percent and solder to 0.2 percent.”

The child care facilities that had elevated lead levels were remediated at the “higher EPA action level,”  which is 15 parts per billion, said Ed Norman, who heads up children’s environmental health for DHHS.

According to rules adopted  on October 1, 2019 by the North Carolina Commission for Public Health, child care facilities that have been in service for more than one year, “must test all drinking water faucets and food preparation sinks for lead contamination” every three years.

“We were only remediating the water at the higher EPA action level, the first go round,” Norman said. “So we will see some centers that come back with levels between 10 and 14 ppb, because we now have implemented a lower action level for North Carolina for childcare centers and for schools, (which is 10 ppb).”

The ongoing study is overseen by Clean Water for Carolina Kids, a program established by RTI that teaches child care providers “the participatory” approach to properly collecting tap water samples. The child care workers use kits provided through the program to collect and then ship samples back to RTI to be analyzed.

Hoponick Redmon says she expects EPA funding for the Clean Water for Carolina Kids program to continue until at least 2025. In addition, there may be funding available through the American Rescue Plan Act (ARPA) to support the program. 

Child care facilities that would like to participate in the program can do so by visiting https://www.cleanwaterforcarolinakids.org.

According to Norman, early next year lead and asbestos remediation will begin in North Carolina public schools. Money allocated from the American Rescue Plan Act, totaling $150 million, will fund the project. A portion of that money, $32.8 million, will be used to test for lead contamination in water fountains and kitchen faucets in public schools and to install water filters.

When comparing the child care center lead testing initiative with the upcoming public schools project, Norman says it’s similar but larger in scope. 

“There’s fewer schools than there are child care centers, but the schools are larger,” he said. “We’re actually expecting to collect maybe close to 200,000 water samples over the next 18 months, once we get started. We tested all 4,400 of those childcare centers with about 24,000 samples. So we’re looking at something that’s going to be maybe 10 times bigger than that, in terms of testing.” 

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Will Atwater

Will Atwater has spent the past decade working with educators, artists and community-based organizations as a short-form documentary and promotional video producer. A native North Carolinian, Will grew...