Take the lead on lead poisoning

Through much of the 20th century, lead was a common part of American life. It was used in paints, plumbing fixtures, water pipes, and many consumer goods. Automobiles guzzled leaded gasoline to improve engine performance. Meanwhile, the medical community increasingly recognized the toxic effects of lead on the body, particularly in children. Since the 1970s, sweeping regulations have dramatically reduced lead exposure in our homes, products, and environment.

Unfortunately, the lead poisoning epidemic is far from behind us. A recent study in JAMA Pediatrics found that more than half of children tested around the country had detectable levels of lead in their blood. Continued concerns have recently led the Centers for Disease Control and Prevention (CDC) to reduce the blood lead reference value, which is used to identify the highest-risk patients.

Here's what you should know about the new guidelines, the sources and dangers of lead exposure, and how to protect yourself and your family.

How could I be exposed to lead?

Although consumer uses were banned by the federal government in 1978, lead-based paint remains the most significant source of lead exposure. In homes built before 1978, peeling, cracking, or otherwise deteriorating lead paint can be hazardous, along with the dust created from frequently touched surfaces such as doors, windows, and stairways. This exposure commonly arises from normal hand-to-mouth behavior in an environment with dust that is contaminated with lead. Young children are more likely to have elevated blood lead levels because of differences in how they interact with their environment. Nutrition also plays a role: if children have iron deficiency, they are going to absorb more lead from their gastrointestinal tracts than children without iron deficiency.

Other potential sources include

• drinking water: lead can enter the water supply through corrosion of lead-containing plumbing and fixtures
• workplace: jobs in manufacturing, construction, and mining may involve working with lead that can be carried home on hands and clothing
• consumer goods: lead can be found in toys, jewelry, and cosmetic products, especially antique items or those imported from other countries.

Importantly, the burden of lead exposure is not uniform. Black, low-income, and immigrant populations are most likely to have elevated lead levels compared to the national average.

What are the health effects?

There is no safe level of lead in the body. Children under 6 years old are the most vulnerable because their bodies are rapidly growing and developing. Symptoms may not be present immediately, but exposure to even low amounts of lead can damage the brain and nervous system. Long-term effects on learning, hearing, attention, and behavior can occur.

In pregnant women who have been exposed, lead can be released from the bones and cross the placenta. This can impact the fetus's nervous system and growth. There is also a risk of premature delivery or miscarriage.

What do the new CDC recommendations mean?

The blood lead reference value represents the highest 2.5% of blood lead concentrations in children ages 1 to 5. Lead levels above the reference value may prompt follow-up investigation or testing. In October 2021, the CDC announced that the blood lead reference value would be reduced from 5 micrograms per deciliter to 3.5 micrograms per deciliter, the first change in nearly 10 years. Lowering the value means that more children will be identified as having exposure to the potentially negative effects of lead. It also lets public health and environmental officials focus lead reduction efforts on the highest-risk communities.

If my child has been exposed to lead, what should I do?

Children with exposure to lead may need follow-up measures, depending on how elevated the blood lead level is. Your doctor may recommend a more detailed assessment of potential sources of lead in the home and environment, repeat testing, and nutritional counseling to improve calcium and iron in the diet. Treatment to remove lead from the body may be required for children with the highest blood lead levels.

Local health departments, childhood lead prevention programs, and regional pediatric environmental health specialty units can be additional resources for families at the greatest risk for lead exposure.

When should my child be tested?

The Massachusetts Department of Health recommends that all children be tested for lead at 9 to 12 months, 2 years, 3 years, and at 4 years if a child lives in a high-risk community (as defined by the local department of health). Blood lead testing may be indicated in additional settings, such as if a sibling has an elevated blood lead level, children with persistent oral exploratory behaviors, unexplained anemia, and other risk factors.

How can I make my home lead-safe?

Lead exposure is ubiquitous in our environments and remediation is costly. If not done safely, renovations can worsen pediatric lead exposure by generating lead-laden dust. Families with concerns for lead exposure should have their homes evaluated by a certified lead inspector. Based on these findings, the lead-hazard remediation work should be conducted by a lead-certified contractor, or by those that have received training to conduct deleading.

In the interim, temporary mitigation measures can be helpful to reduce lead exposure. These include minimizing ongoing exposure (such as by covering chipping interior paint using contact paper or duct/masking tape), frequent hand washing, frequent dusting/wet mopping of the home (several times per week), leaving shoes at the door, and eating an iron- and calcium-rich diet.

The bottom line

While exposure to lead has decreased significantly in recent years, it remains an important public health problem. You should speak with your pediatrician about routine testing for your child, and the ways to minimize lead hazards and prevent long-term health effects. More funding is needed to help families and property owners mitigate lead-based paint and other hazards in their homes. These steps, along with the work of the public health and medical community, can help make the lead poisoning epidemic a thing of the past.