Lead & Lead Poisoning
Environmental toxins cause a great deal of concern to both parents and pediatricians. Lead was among the earliest identified environmental toxins.
We’ve known for a long time that lead poisoning in children results in growth and developmental problems, including permanent learning difficulties. At high levels, lead poisoning may cause sluggishness, irritability, poor growth, weight loss, abdominal pain, constipation, or vomiting. At very high levels, lead poisoning can be fatal. At low levels, the effects of lead poisoning can be difficult to detect, but can still cause problems over time. It may build up over months or years of exposure. In recent years it has become clear that detrimental effects also occur even with very small amounts of lead exposure.
We routinely check blood lead levels in at-risk children, usually when they’re 9 months old. We also check lead levels whenever concern is raised by a child’s symptoms, or by their exposure scenario. The only blood lead level that is safe and normal is zero. Depending on the lab, this is usually reported as “less than 4 ug/dL.” Blood lead levels lower than than 4 ug/dL are considered undetectable.
If your child’s blood lead level is higher than 4, it means he/she has been exposed to lead. Even though it may not be obvious to you where the lead is coming from, it’s important to survey your child’s environment and remove the source of the lead. Take into consideration all of the places where your child spends time, not just your home.
Common Sources of Lead Exposure
Commonly we talk about “paint chips,” but lead can also be released from paint as a fine dust. This most often occurs when the painted surface is rubbed or touched. Even paint that appears stable and not-peeling could be shedding lead. In fact, one of the reasons lead paint used to be so popular was because it shed regularly, thus maintaining a “clean,” like-new appearance.
Importantly, lead dust may be invisible to the naked eye. The particles are tiny and can become airborne and inhaled. When children put their hands into their mouths, or when adults prepare food without washing their hands, lead dust can be ingested.
Lead paint was outlawed in the US in 1978, but was used widely prior to that. Even if your home is new, consider furniture (especially furniture with drawers or doors that swing, rub, or scrape) that could have been painted earlier with lead-based paint.
Lead paint may be present on some products, including toys, that are old or were manufactured abroad. Use caution when allowing children to mouth painted toys. Of particular concern is inexpensive toy or costume jewelry. Children should not be allowed to chew or suck on metal or painted jewelry.
House and car keys may contain up to 2% lead. Do not ever allow children to handle or mouth your keys, and always wash your hands after handling keys and before preparing food.
Certain cosmetics, including lipstick and lipgloss, may contain small amounts of lead. The FDA does provide some regulation of these items, but it assumes that these products are not used by children and are not ingested. Because small children are more sensitive to lead poisoning, it’s not clear that the FDA regulations make these products safe for kids.
When water comes in contact with lead plumbing it may become contaminated. Lead was used commonly in water pipes, soldered plumbing joints, and wells because of its resistance to corrosion. Lead solder has been outlawed for use in household plumbing since 1986, and other fixtures are regulated as well. Older homes may still have lead pipes or fittings that allow lead to enter the water supply.
Sheet lead was used in roof flashing and other building applications because of its pliability. Water runoff that comes in contact with these materials may be contaminated.
Leaded gasoline was recognized as harmful in the 1970’s, and was phased out gradually over the next two decades. Unfortunately, lead-containing fumes from leaded gasoline have contaminated the soil near heavily-traveled roads. In addition, water runoff from building sites or factories may contaminate nearby soil. Children should be encouraged to play on grassy areas rather than in the dirt. (As an aside: When plants are grown in highly-lead-contaminated soil, the roots and leaves may take up the lead. If you grow and eat from an urban garden, there are steps you can take to reduce your risk.)
Lead solder was prefered in electronic components and circuit boards for decades because of its conveniently low melting temperature. It is being phased out, but it continues to be used by hobbyists and may be present in older electronics.
Again, lead solder was commonly used in stained glass work. If parents are working in stained glass restoration or similar fields, they could potentially carry lead contamination home on their hands or clothing.
A variety of imported folk remedies may contain lead.
Lead-acid batteries, including car batteries, contain lead which may be released if the batteries are improperly recycled.
Tips to Avoid Lead Exposure
- Be alert to sources of lead in your child’s environment.
- Kids who eat regular meals high in iron and calcium, and low in fat, are less likely to absorb lead from the environment.
- Children (and adults) should wash their hands often, and always before eating, handling, or preparing food.
- Keep your home clean and free of dust. Wash toys, bottles, and pacifiers often.
- Lead testing kits available at hardware stores tend to be unreliable and are not recommended.
If you’re concerned about lead poisoning, make an appointment to discuss your child’s risk with a provider. A lead test can often be performed on a very small drop of blood obtained with a fingerstick.
If your child has an elevated lead level and you need assistance correcting the situation, contact the Pennsylvania Department of Health LEAD LINE at 1-800-440-LEAD. They can provide home inspections. There’s also a great deal of information on their website.
Dr. Kerry McGee is a former Kids Plus provider.