Childhood Lead Poisoning Prevention Outreach Module Welcome to the Rocky Mountain Region Pediatric Environmental Health Specialty Unit’s brief learning module about lead issues for children. In this module we will discuss the impact lead has on children’s learning and development, look at the impact environmental lead has on children living in Colorado, and offer recommendations to identify and treat lead poisoned or exposed children. We invite your comments about the lead learning module. Please contact us on the web at www.rmrpehsu.org or call us at our toll-free, national access, 24 hour phone line: 877 800 5554, located in the Rocky Mountain Poison and Drug Center in Denver, Colorado

Why Lead is Dangerous for Young Children Lead is a toxic metal found in the environment Children 6 months to 6 years are at risk Kids absorb more from hand to mouth activity Can cause developmental delays because it interferes with how the brain matures First, let’s discuss why this is an important issue for children. Lead is a metal that is found ubiquitously in the environment. While everyone, young and old may be exposed, children are at special risk for absorbing the lead due to some of their behaviors. While a normal 9 month old may place everything within arm’s reach into his mouth, this would be an unusual adult behavior. Children, especially infants, often play on or crawl upon the floor. This normal play activity, coupled with normal hand to mouth behaviors not only potentially exposes infants to lead to a greater degree, but also makes children more likely to absorb any lead they are exposed to. Infants and children are growing and developing very rapidly, unlike adults, and this places them at special risk as well. Children under 6 years of age are at greatest risk. Lead can cause multiple developmental problems, including learning delays.

Common Sources of Lead in a Child’s Environment Paint and dust Soil Water Toys, vinyl miniblinds Pottery from foreign places As mentioned previously, lead is found everywhere in the environment. Many sources of lead arise from things we make, especially items containing dyes or metals. Older paint is most famous for its lead content, and while lead-containing paint was used in older homes in the West, Colorado does not have the lead paint burden of much older Eastern cities. However, if a child lives in an old home, testing for lead exposure if very reasonable. Other lead sources include soil, water, toys, and pottery.

Other Sources of Lead Keys Pewter Home remedies Glaze on old bathtubs Soil contaminated from leaded gasoline Keys and pewter may be sources of environmental lead for children. A child should never be allowed to place or mouth these objects. Items that are painted or contain dyes may also be a source of lead for children.

Lead Sources Soil near heavily-used streets and roads may contain lead because lead was used in gasoline production. Lead may also be found in the soil next to homes that previously had been painted with lead-based paint. Lead in soil can contribute to high levels of lead in household dust. In the past, lead was used as an additive to gasoline. Consequently, soil near heavily traveled roadways may contain dangerous amounts of lead. Similarly, soil may be contaminated around older homes that may have been painted with lead containing paint. Special precautions should be taken to avoid soil contamination when repainting older structures. At a minimum, children should not be allowed to play in such soil. All children, in both old and new homes, should wash their hands after playing in soil and before eating. http://www.niehs.nih.gov/kids/lead.htm

Lead Sources Lead may get into drinking water when lead-containing materials are used in plumbing parts, such as pipes, solders, and brass or chrome plated faucets; any of these components may begin to corrode and break down Pipes and compounds used to join pipes may contain lead. This presents a possible environmental source for children when they drink water that has flowed through contaminated plumbing. http://www.niehs.nih.gov/kids/lead.htm

Lead Sources Ammunition Plastic mini-blinds Stained glass Fishing sinkers Yellow road stripes Pool cue chalk Cosmetics Colored newspapers Hair dyes Plastic mini-blinds Old toys / imported toys Lead painted pottery Leaded crystal Inks Artists paints Ammunition Dishes Lead is ubiquitous in our environment. This is a partial list of potential lead sources. Many sources may arise from hobbies we engage in or from our type of work. If you are concerned, have your child tested for lead, certainly if you engage in work or hobbies that may pose a special risk to children. http://www.niehs.nih.gov/kids/lead.htm

Source: American Family Physician Lead Producers Battery manufacturing Chemical industries Construction & demolition Firing-range instructors Foundry workers Gas-station attendants Jewelers Lead miners & smelters Pigment manufacturing Pipe fitters Plastics industry Printers Radiator repair workers Rubber industry Solid waste production Stained-glass makers Welders Here are some of the industries and occupations that may involve use of or exposure to lead. A parent working in any of these fields must be extremely cautious about changing clothing and hand washing so as not to expose family members, especially children, to lead. Children whose parents engage in these work activities should be screened for lead exposure. Source: American Family Physician

lower level lead exposure…results “Deficits in cognitive and academic skills associated with lead exposure occur at blood lead concentrations lower than 5 μg/dL” Much of the past scientific work dealt with acute toxicity of lead and neurobehavioral or cognitive outcomes from high levels of lead. Children with high level exposures can still be found but more recent scientific work has focused on children with lower levels of lead. Work done by Dr. Lanphear and his colleagues suggested that low levels of lead, below 10 micrograms per deciliter, are quite harmful as well. Demonstrable decrements in IQ are seen in children who have lead levels below 10, a level previously thought to be OK or normal. Lanphear, et al. Public Health Reports 2000 (115); 521-529.

lower level lead exposure…results Study repeated prospective Similar results Demonstrable decrements in IQ Effects greatest at lower lead levels The same group of researchers took the next step and showed similar effects from low lead levels in a prospective manner. Published in the New England Journal of Medicine in 2003, Dr. Canfield and his collaborators showed the same decrement in IQ for children with lead levels below 10, and they did so in a scientifically rigorous, prospective manner. The study also demonstrated that increases in low lead levels look to be more damaging than similar increases at high levels. For example, increasing from a level of 2 to 7 micrograms per deciliter would be more damaging to a child than an increase from 32 to 37. While a lead level of 37 is cause for alarm, a level of 7 should prompt some concern and intervention on the child’s behalf. A lead level of 7 would not be considered concerning by many public health agencies currently. Canfield R L, et al. NEJM 348(16):1517.

Two screenings suggested 12 months of age anemia 24 months of age levels typically higher once before 6 years of age if not done previously Two screenings for lead exposure are recommended for children, the first at age 1 and a second screening at age 2. Two screenings separated by a year are recommended because children are at different levels of risk depending upon their age and their normal developmental behaviors. At age 1, screening for anemia is also recommended. This is important because anemic children, most commonly caused by iron deficiency, will absorb lead in their diet at a greater rate than children who are not anemic. Identifying and treating anemia will also help children with elevated lead levels.

The only way to know if your child has high lead levels Ask your doctor for a blood lead test The only way to identify lead exposure for a child is to have a blood lead test done.

Protect Yourself From Lead….. Wash your hands before you eat Take off your shoes at the door Eat a healthy diet that includes iron and calcium Health advice to avoid lead exposure for children and their families is simple. Wash hands prior to each meal. Remove shoes at the door to the house. Eat a healthy diet high in calcium and iron. Have children screened for lead at ages 1 and 2 years.

Is Lead Hiding In Your Home? A typical house may contain several potential lead sources. Chipping or peeling paint should be repaired and children should never be allowed to eat paint chips or mouth windowsills in the home. http://www.niehs.nih.gov/kids/leadhouse.htm

Lead Resources On The Web National Safety Council http://www.nsc.org/library/facts/lead.htm CDC http://www.cdc.gov/nceh/lead/faq/cdc97a.htm American Academy of Pediatrics http://www.aap.org/ Alliance To End Childhood Lead Poisoning http://www.aeclp.org/ National Institute of Environmental Health Services http://www.niehs.nih.gov/kids/lead.htm The Lead Group http://www.lead.org.au/fs-index.html Housing Urban Development (HUD) http://www.HUD.gov/offices/lead/ Lead has been known to be an environmental toxin for many years. Multiple resources are available as seen here an on the next slide.

Points of Contact National Lead Information Center 1-800-424-LEAD EPA’s Safe Drinking Water Hotline 1-800-426-4791 Consumer Products Safety Commission Hotline 1-800-638-2772 Housing & Urban Development (HUD) Office of Lead Hazard Control 202-755-1785 Not only are these national resources available….but

Points of Contact Rocky Mountain Poison & Drug Center 303-739-1123 1-800-332-3073 Colorado Department of Public Health & Environment 1-800-886-7689 Blood-Lead Testing Contact your doctor Colorado has some resources of its own, including the Rocky Mountain Poison and Drug Center and the Colorado Department of Public Health and Environment. Contact your child’s doctor for a lead screening.

Finally, the Rocky Mountain Region Pediatric Environmental Health Specialty Unit is available for more information. Thank you.