Health alert: New lead poisoning limits for kids -- Part I 4/12
(This article is adapted from the March 2012 Consumer Reports magazine.)
Part I: Lead poisoning | Part II: Reducing exposure
What blood lead level constitutes lead poisoning in children? A January 2012 draft report issued by an advisory committee of the Centers for Disease Control and Prevention (CDC) says the limit, or threshold of concern, should be lower to protect children.
The report, based on the latest science showing that adverse health effects in children can take place at a blood lead level (BLL) of 5 micrograms per deciliter of blood (5mcg/dL), argues that the current level of concern—allowing 10 micrograms per deciliter—is too high. This makes it more crucial to protect children from exposure to lead in the first place, according to the report.
Lead can be toxic to people of any age, but young children are at greatest risk because their bodies absorb more of it, and they are more vulnerable than adults to the effects of lead exposure. Hundreds of thousands of children in the U.S. have elevated levels in their blood, according to the National Center for Health Statistics.
Even at the proposed lower limit, 5 mcg/dL, lead in the blood can have adverse health effects on a child’s cognitive function, academic performance, and endocrine systems—effects that may be irreversible.
Too much lead in a child’s blood may lead to anemia, decreased muscle and bone growth, hearing damage, learning disabilities, nervous system and kidney damage, speech, language, and behavior problems, and brain damage. At extremely high levels (about 70 mcg/dL), it can cause severe neurological effects in children, and lead to lethargy, convulsions, coma, and even death. But even at extremely low levels, the World Health Organization reports, effects have been observed on the metabolism, kidneys, and cardiovascular symptoms.
The good news is that since the 1970s, the average blood lead levels in children younger than 6 has dropped by about 90 percent because of a federal ban on lead in house paint and gasoline. Still, in the U.S., lead-based paint hazards, including deteriorated paint and lead-contaminated dust and soil, remain the largest contributors to childhood lead exposure. And children between the ages of 1 and 5 have consistently higher BLLs than any other age group because they handle lead-contaminated dust, soil, paint, toys, and more.
Pregnant women should be screened
A fetus can be exposed to lead in the womb, since it can cross the placenta, and as a result, infants are usually born with a lead blood level similar to that of the mother. This lead transfer can contribute to adverse effects in the fetus, including reduced growth and kidney damage. Currently, the CDC recommends follow-up blood lead testing and interventions for pregnant women whose blood lead levels are equal to or greater than 5 mcg/dL.
Since no amount of lead in the blood is safe, the report recommends that public health, environmental, and housing policies increase awareness of the hazards, prevent the exposure to children (vs. after-the fact intervention), and help children with high lead levels with nutritional intervention.
As recently as January 2012, Consumer Reports reported on lead in fruit juice. "The science has been indicating for some time that there may be no safe limit of lead for children, who are more vulnerable to its toxicity," says Urvashi Rangan, director of Consumer Safety and Sustainability for Consumer Reports. "A lower lead tolerance for children makes total sense."
Checking for and preventing lead poisoning
It's important for all pregnant women and young children to be screened. Here’s how you can work with your doctors to manage your child’s lead exposure or your own.
Start with a blood test. Children should be tested for blood lead levels even if they seem healthy, particularly if they’ve never been tested before or meet certain criteria, such as living in a home built before 1978.
It’s important to have a pediatrician screen your child because blood lead levels can rise if you (or even your child’s day care provider or babysitter) start to renovate, or if other exposures increase unexpectedly (say, your child gets a new toy that contains lead). Given the uncertainty of individual blood lead test results, be sure to confirm the results with the pediatrician because levels can be affected by residual lead on the skin at the puncture site. If one of your children has a high blood lead level, consider having your other children tested since there's a likelihood of similar exposure.
The CDC recommends initial and follow-up screenings for pregnant and lactating women, as well as for newborns and infants of women with BLLs higher than or equal to 5 mcg/dL. If you are pregnant or lactating and have recently immigrated from or reside in areas where lead contamination is high, such as countries where leaded gasoline is still being used (or was recently phased out), or where industrial emissions are not well-controlled, you may also want to be screened for lead, since it can cross the placenta to the fetus.
Experts say it’s important to ask your doctor for the actual level (and not just get an assurance that the level is "safe" or "unsafe," for example) because the doctor might not be up to speed on the latest CDC recommendations or be worried about levels between 5 and 10 mcg/dL—just under the current federal limit.
"If a lead level is too high, then you have to try to figure out where it’s coming from and remediate, ASAP," urges Jean Halloran, Consumer Reports’ Food and Product Safety Campaign Director.
Immigrant and internationally adopted children
The American Academy of Pediatrics (AAP) suggests that pediatricians screen all immigrant, refugee, and internationally adopted children when they arrive in the U.S. due to their increased risk for lead exposure. According to the CDC, the risk is higher in many countries where children are adopted before moving to the U.S., and the agency also recommends that any adopted child get a blood lead test during a medical examination in the U.S.
Children from some immigrant communities are at greater risk of having a higher BLL, and having it outside of the typical 1- to 5-year-old age range, according to the advisory board’s report, so it recommends that immigrant children of all ages—including international adoptees—be tested for lead exposure, with home evaluation to identify sources if needed.
Children with developmental delays
Developmentally delayed children who have hand-to-mouth behavior beyond the typical age range should also be candidates for continued monitoring.
Nutrition is a key weapon
Since certain vitamins and minerals, especially calcium, iron and vitamin C, play a role in minimizing lead absorption, discuss nutrition with a pediatrician. A healthy diet can help reduce lead absorption. But since excess iron can be toxic, talk about a healthy nutrition plan for your child before making any diet or supplement changes.
Get more information
If your child’s pediatrician (or your ob/gyn) is not familiar with treatment protocols for lead exposure, the doctor should consult with a medical toxicologist and/or regional Pediatric Environmental Specialty Health Unit (PESHU), or a clinician experienced in treating children with elevated BLLs. Other sources of information for clinicians and consumers include the National Pesticide Information Center and CDC’s Lead Poisoning branch.
New federal bill to limit arsenic and lead in juices. 2/12
CDC advisory group proposes lower limit for lead poisoning in children. 1/12
Greener Choices Toxics search: Lead.
Greener Choices Electronics Reuse & Recycling Center.
Part I: Lead poisoning | Part II: Reducing exposure