1. Educational Presentation
How to Reduce Lead Poisoning in Children Who Reside in Shelby County Tennessee
Marilyn Renae Burress
Walden University
PUBH
Instructor: Dr. Jeff Wu
July 31, 2009

2. Lead Poisoning in Shelby County Educational Presentation by Marilyn R
Lead Poisoning in Shelby County Educational Presentation by Marilyn R. Burress Walden University Ph.D. Student July 31, 2009
Hello, My name is Marilyn Burress and I am a student at Walden University. I will be presenting some valuable information regarding lead poisoning in Shelby County and will be discussing ways to keep your children safe from lead poisoning.
Thank you for taking time out of your busy schedules to participate in this presentation. 2

3. Today’s Learning Objectives
What is lead?
Sources of lead poisoning.
How to detect lead poisoning?
How lead affects children?
How lead is detected?
What is the lead poisoning status in Shelby County?
What can we do in Shelby County to
reduce childhood lead poisoning?
There are several things that I would like for us to accomplish today. I hope to enhance your knowledge about lead poisoning and offer several ways to reduce childhood lead poisoning in our community. 3

4. What is lead? It’s a natural element that is: Common/Everywhere
Pewter, crystal, vinyl, jewelry, pottery
Hobby exposure, commercial exposure
Industrial exposure, occupational
What is Lead? Lead is a natural element. It is common everywhere.
Lead is a soft, blue-gray metal. Much of its presence in the environment stems from its historic use in paint and gasoline and from ongoing or historic mining and commercial operations.
Lead is a naturally occurring metal.
Lead is still used widely in commercial products.
Lead is very stable and accumulates in the environment.
The body absorbs lead (as was used in leaded gasoline and is used in occupational settings). 4

5. Lead May Be In Your Water.
Lead can come from:
●Lead plumbing, or
fixtures in your home
●Low Lead in Shelby County water supply system
Lead occurs in drinking water through leaching from lead-containing pipes, faucets, and solder, which in turn can be found in plumbing of older buildings.
Homes built before 1986 are more likely to have lead pipes, fixtures and solder, although newer homes may also be at risk. Boiling water will not get rid of lead.
Please don’t be alarmed your drinking water is safe, there are many activities that take place by governmental agencies to ensure that your drinking water is safe. There is a very low lead in our water system supply in Shelby County. 5

6. Other Sources of Lead ● Old paint in home environments Soil
Some ceramic items
Some toys
Prior to the 1970s, lead was widely used in paint and gasoline.
Lead paint is a primary source of environmental exposure to lead. Lead may be released from old paint in home environments if the paint is disturbed for example renovations, deteriorated (peeling, chipping, and chalking), or subject to friction or impact (doors, windows, porches, etc…)
The past use of lead in gasoline and paint can result in high lead levels in soil and historic or ongoing lead-related industries (including mining and smelting) can result in high lead levels in surrounding soil.
Some commercial products still contain lead such as ceramic items and toys. 6

7. Lead May Be in Food and Beverages
It can come from
Production
Packaging
Storage
Even when lead is not intentionally used in a product, it may contaminate items such as food, water, or alcohol. Lead may contaminate food during production and processing packaging and storage.
Production
Production sources may include root vegetables uptake from soil
Atmospheric lead deposition into leafy vegetables
Grinding or cutting equipment during processing
Packaging
Lead in packaging may contaminate food.
Bright red and yellow paints on bread bags and candy may contain lead
Although lead was phased out of cans in the U.S. in the 1980's, some imported cans may still contain lead.
Storage
Food or beverages may be stored in lead-containing vessels that contaminate the product.
Even "safe" pottery and ceramic-ware can become harmful if the protective glaze wears off and exposes people to lead-containing pigments.
Lead-glazed pottery, particularly if it is imported, is a potential source of exposure that is often overlooked.
Wine and homemade alcohol that was distilled and/or stored in leaded containers.
Wine or other alcoholic drinks stored in leaded-crystal glassware may become contaminated. 7

8. Why Lead Is Especially Dangerous For Young Children?
Because they are:
are still developing
absorb it more easily
are more likely to put things in their mouths
Because of their behavior and physiology, children are more affected by exposure to lead than are adults.
Children absorb more ingested lead than do adults.
Children generally ingest lead-contaminated soil and house dust at higher rates than adults because of mouthing and hand-to-mouth behaviors.
Children who exhibit pica, a compulsive hand-to-mouth behavior and repeated eating of nonfood items, are at greatest risk.
Children have a higher breathing rate than adults, breathing in a greater volume of air per pound.
Being shorter than adults are, children are more likely to breathe lead-contaminated dust and soil as well as fumes close to the ground. 8

9. Lead poisoning is Hard to Spot.
Upset Stomach
Loss of Appetite
Constipation/Diarrhea
Hyperactivity/Listlessness
Mimic the Flu
Lead poisoning has no obvious signs, and most children do not report any abnormal symptoms. Children with lead poisoning might report stomachaches, decreased appetite, hyperactivity, sleeping problems or irritability. Because these symptoms appear to mimic other childhood problems, lead poisoning is sometimes mistaken for a cold or the flu.
Sometimes There Are No Symptoms. 9

10. How Can You Tell If A Child Has Lead Poisoning?
Screening is the only way
to know for sure.
The only way to diagnose lead poisoning is by having a blood test. A doctor or nurse takes blood from a child’s finger or arm. The health care provider sends the blood sample to a laboratory to find out how much lead it contains. All children 6 months through 6 years of age who are entering day care, preschool or kindergarten must be assessed for lead poisoning by a health care provider. 10

11. Lead Affects the Brain and Nerves Even At Low Exposure Levels.
This may cause:
Learning Problems
Growth Delays
Violence/Crime
Aggressive Behavior
Lead poisoning is related to a number of serious health problems. Children with elevated lead levels may suffer from learning disabilities, mental retardation, behavioral problems, lowered IQ, stunted growth and hearing impairment. Some recent studies claim that childhood lead poisoning can contribute to problems later in life, such as academic failure, juvenile delinquency and high blood pressure. 11

12. Effects Of High Lead Levels.
Severe damage to the nervous system,
including the brain
Convulsions or coma
Even death
Convulsions, coma and death can occur at higher lead levels. 12

13. Death of a Child After Ingestion of a Metallic Charm --- Minnesota,2006
Heart-shaped charm bracelet that is the subject of a voluntary recall announced March 23, 2006 by Reebok International Ltd. and the Consumer Product Safety Division
Source: MMWR, Retrieved July 29, from
This is an example of lead poisoning in a child.
4 yr old – ER Vomiting – diagnosed with viral gastroenteritis
2 days later in ER vomiting, sore tummy, dehydrated and listlessness
Next day child became agitated and combative - suffered respiratory arrest & seizure
Child was given a CT scan where a heart-shaped object was observed in the radiographs, but it was thought to be a radiopaque temperature probe in his body.
The next day :
●A mistake was noticed and a BLL was drawn on the child 180 µg/dl
Cerebral blood flow studies indicated no flow to the brain.
On the fourth day the child was removed from life support and died
Autopsy revealed a heart-shaped charm imprinted with Reebok
Charm tested at 99.1% lead – should have no more than 0.06% 13

14. 10 CDC Action Level What is lead poisoning?
Lead poisoning is the presence of too much lead in the body. The most common preventable pediatric health problem in the United States today, it is caused by exposure to lead that is either eaten or breathed, in the form of dust. The body carries the lead in the blood to soft tissues and bones, where it can be stored for many years. Lead harms several organs, including the nervous system and kidneys.
Remember, the only way to diagnose lead poisoning is by having a blood test. A doctor or nurse takes blood from a child’s finger or arm. The health care provider sends the blood sample to a laboratory to find out how much lead it contains.
A level of 10 micrograms per deciliter (mcg/dL) or greater is considered unsafe.
No amount of lead in the body is acceptable
10 CDC Action Level 14

15. Shelby County Today 170,744 homes in Shelby contain Lead Based Paint.
23,455 children in Shelby County are below the poverty level.
Hundreds of new children are diagnosed with Lead Poisoning every year.
Source: Shelby County Government Website
Shelby County houses two times the National Average of Lead Poisoned children.  There are a total 362,954 housing units across Shelby County.  170,744 of these units (47%) were built before 1969 and contain Lead Paint.
According to the most recent Census Data there are 23,455 children in Shelby County below the poverty level.
In 2008, 17,188 were children screened for Lead Poisoning in Shelby County and 354 (2%) screened were found to have elevated blood lead levels. . 15

16. Shelby County Today Cont.
◦ Children living below the poverty level are 13 times likely to become lead poisoned.
◦There are over 68,000 children under age 5 residing in Shelby County, on 32% are being tested for lead poisoning by their medical provider.
◦ In Shelby County, we are screening a small percentage of the high risk population
◦ Every child under the age of six living in high risk areas should be screened.
According to the most current census data the total population of Shelby County is 897,472.  140,398 of theses citizens are below the US Poverty level. Children living below the poverty level are 13 times more likely to become lead poisoned. There are 68,427 children under the age of 5 residing in Shelby County.  Currently only 32% of these children are being tested for Lead poisoning by their Medical Provider.  Of these children being tested 5% are identified with dangerous level of lead in their blood.  Across the United States only 1.82% are identified with lead poisoning.
Every child under the age of six living in a high risk area needs to be screened. 16

17. Shelby County 10 year Elevated Blood Lead Stats In children under 72 months old
As you can see from this slide. Shelby County has experienced many children with elevated blood levels for the past 10 years. In recent years the numbers have declined, however there is still a need for education in Shelby County Tennessee. 17

18. High Risk Census Tracks
The high risk areas in Shelby County are in the following zip codes:
Greenlaw Community (38107)
New Chicago (38107)
Orange Mound (38114)
Riverview (38126) 18

19. The Problem
Childhood lead poisoning is a major, preventable environmental health problem.
Lead poisoning is entirely preventable. The key is stopping children from coming into contact with lead and treating children who have been poisoned by lead. The goal is to prevent lead exposure to children before they are harmed. There are many ways parents can reduce a child’s exposure to lead. The key is stopping children from coming into contact with lead. Lead hazards in a child’s environment must be identified and controlled or removed safely.

20. What can we do in Shelby County to Decrease Childhood Levels………….
Now that we know there is a problem with childhood lead in Shelby County. What can we do to reduce the risk for our children? 20

21. Clean With Care. Always wet mop & wet dust
Use high phosphorus cleaning products.
Use the right cleaning methods.
Vacuum carefully.
Keep children away from painted items.
Wash toys and other items frequently.
There are ways we can reduce childhood lead in our community. As parents it is important to ensure that we are cleaning with care. Here are some simply was to clean with care.
Make sure you stress to your child the importance of washing their hands often. This includes before and after they eat and after
using the restroom.
Let the water run a few minutes before we use it.
Try to make sure your child avoid massive amounts of direct.
Wash your child up when he/she comes in from playing outside. 21

22. REVIEW Lead-based paint and lead dust are
the leading sources of lead poisoning.
Lead poisoning has no signs.
Testing is the only way to know if your child
has lead poisoning.
Lead poisoning is related to a number of
serious health problems.
Lead poisoning is the presence of too much
lead in the body.
Shelby County has experienced many children with elevated blood levels.
Every child under the age of six living in a high area needs to be tested.
There are ways to reduce lead poisoning in our children in Shelby County.
There are ways to keep your children safe.
This is a review of what we discussed today.

23. How Else Can You Keep Your Child Safe From Lead Poisoning?
Wash hands often.
Run water before using it.
Never use hot tap water when cooking.
Avoid dirt play areas.
Wash up after playing outside.
There are other ways to keep your child safe from lead.
Make sure you stress to your child the importance of washing their hands often. This includes before and after they eat and after using the restroom.
Let the water run a few minutes before we use it.
Try to make sure your child avoid massive amounts of dirt.
Wash your child up when he/she comes in from playing outside. 23

24. Serve A Variety Of Healthy Foods Every Day.
Choose Nutrient-Rich Foods.
Vitamin C
Calcium
Iron
Eating a healthy diet is important in reducing childhood levels. Choosing foods that are high in Vitamin C, Calcium and Iron are important in the daily diet of children. Good nutrition can reduce the amount that will actually be absorbed inside the body. Eating regular meals is helpful because lead is absorbed more during fasting. 24

25. The Memphis/Shelby County Health Childhood Lead Poisoning Prevention Program
PROGRAM FOCUS:
Medical Case Management/Tracking of Lead Poisoned Children
Environmental Case Management/Tracking of properties with Lead Hazards
Preventative Exposure Program
In addition to the things that I just discussed pertaining to reducing lead poisoning in children, there are programs in the Shelby County area that focuses on lead poisoning prevention. This is a great program at the Shelby County Health Department and there has been success with reducing lead poisoning in Shelby County. 25

26. Partnering gets the job done!
Creation of Lead Safe Housing!
Screening of children in high risk areas.
Education/Outreach opportunities.
Faith based Organizations
Day Care Centers
Higher Learning Institutes
Public Educational System
There are other organizations in the community that focus on reducing childhood lead poisoning. They include:
1. Memphis, Shelby County Health Department
2. Lebonhuer Children's Hospital
3. St. Francis Hospital
4. Memphis Healthy Common Table
5. The City of Memphis Division of Housing and Community Development
6. University of Tennessee
7. MidSouth Peace and Justice Center
8. Tennessee State University
Memphis Healthy Churches
All of these organizations sponsor childhood lead paint prevention programs. 26

27. Grant Partnering Housing and Health what a Good Combination!
The Health Department has partnered with Local Housing in providing Environmental testing in all properties receiving HUD funded Lead hazards reduction treatments.
properties receive lead hazard reduction treatments a year
Source: Shelby County Health Department 27

28. Questions
I hope that this presentation enhanced your knowledge of lead poisoning and offered ways to reduce childhood lead poisoning in Shelby County. Thank you and I will answer questions at this time. 28

29. References
Shelby County Government. Facts on Childhood Lead Poisoning. Retrieved July 15, 2009 from: Agency for Toxic Substance Abuse and Disease Registry. Lead Toxicity. Retrieved July 15, 2009 from:
Illinois Department of Public Health. Lead Poisoning. Retrieved July 15, 2009 from
Shelby County Government. Lead Poisoning Statistics from the Memphis and Shelby County Childhood Lead Poisoning Prevention Program. Retrieved July 16, 2009 from:
Berg, K.K., Hull, H.F., Zabel, E.W., Staley, P.K., and Brown, M.J., March 23, Death of Child After Ingestion of a Metallic Charm, Minnesota. Mortality and Morbidity Weekly Report, 55(Dispatch);1-2. Retrieved July 28, 2009 from
Centers for Disease Control and Prevention. Lead Prevention Tips. Retrieved July 27, 2009 from