Screening kids for lead poisoning

The high lead levels in Flint, Michigan’s water supply have been news for several months. There’s been a lot of finger pointing and congressional hearings and such, but the bottom line is that because an agency didn’t do its job properly, the health of many kids was put at risk.

Lead poisoning is especially serious in infants and young children, as it interferes with brain development.

Sadly, the situation in Flint is not unique. Washington, DC, had a similar crisis a few years ago, and just last week my home state, Washington, reported that 34 water systems had lead levels over the EPA limit.

Related story in USA Today: Beyond Flint: Excessive lead levels found in almost 2,000 water systems across all 50 states

Children’s exposure to lead is not always the fault of a public agency, however. Homes built before 1978 might have lead-based paint, or water pipes that contain lead.

And every year, it seems, there are reports of toys or face paints or jewelry manufactured overseas that contain dangerously high levels of lead.

When my son was a toddler, we lived in a Craftsman bungalow built in 1924. Unthinkingly, my husband and I began scraping off layers of paint on the interior trim before we repainted. My son was crawling around in these paint chips for days before I belatedly realized what we had done! I immediately called his pediatrician and asked to have a Blood Lead Level (BLL) done. Luckily for me (and him), it was normal.

We had a scare a year later when the house next door, also built in the 1920s, had its exterior repainted. The paint crew spent days scraping and sanding—lead paint residue went everywhere. I know it was lead because I went to the local hardware store and bought a lead testing kit.

I became so freaked out about lead that when we moved into a newer house, but still built before 1978, I sent a sample of the tap water to a lab to have it tested for lead. It cost about $80, but was worth it for the peace of mind.

So lead is still out there in the environment, and it’s a potential hazard parents need to be aware of.

Medscape, a medical newsletter I subscribe to, brought up the concern that children are not being routinely screened for lead levels.

…elevated lead levels in tap water may be a nationwide problem that has been underestimated and…the Flint crisis presents a wake-up call for family physicians and pediatricians, who have considered the dangers of lead toxicity in everyday life to be of mainly historical interest.

Historical interest because what used to be the major sources of lead poisoning—lead paint, leaded gasoline, and lead plumbing—have all been eliminated. At least in theory.

The Centers for Disease Control (CDC) used to recommend universal lead screening for children 1-5 years of age.

In 1997, the CDC decided to take a more targeted approach, and now recommends screening only children who are Medicaid, Medicaid eligible, foreign-born, or living in high-risk communities.

But how many of those children are really being screened?

A pediatric toxicologist recently wrote in an American Academy of Pediatrics (AAP) newsletter:

Nationally, only 10 percent of children under 3 years of age who should be screened are actually tested for lead exposure. Of these children, 4 percent have been found to have blood lead levels above 5 micrograms per deciliter. While this may not seem high, when the 90 percent of children who are not tested are taken into account, it can be expected that more than 800,000 U.S. children with elevated blood levels continue to be exposed to other lead sources.

Increased public awareness of the dangers of lead has refocused the spotlight on screening.

What’s a parent to do?

Most importantly, be aware of potential sources of lead in your child’s environment. The CDC has a couple of really good webpages:

And the AAP has an informative page, as well:

For information about lead levels in your water supply, check out the EPA page:

It also has a link that will take you to the your community’s Consumer Confidence Report (CCR), an annual water quality report required by the EPA.

Just drinking bottled water all the time is not a good long-term solution because tap water has fluoride, which kids need for healthier teeth.

Related post: Fluoride in tap water

Then talk to your child’s doctor about whether getting a blood test to screen for lead levels is a good idea.

A blood test seems simple enough, but as I’ve said many times on this blog, screening can still lead to harms from over treatment. A low lead level in an otherwise asymptomatic child will still cause anxiety, and the treatment—chelation therapy—probably won’t help and could be more toxic than the lead.

The United States Preventive Services Task Force (USPSTF) also has good information about the pros and cons of lead screening in children on its website:

So know your risks and discuss your concerns with the physician. Then make an informed decision on whether the benefits of screening outweigh the harms.

Sláinte,

Frugal Nurse

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