Lead poisons children. Those words opened a presentation I gave to a national childhood lead poisoning prevention meeting in New Orleans in June of 1981. As I told the audience, "Just as Dickens Christmas Carol begins with the statement, MARLEY was dead: to begin with. There is no doubt whatever about that, there is also no doubt that lead poisons children." At the time I gave the presentation, old lead-based paint applied to many residences again and again over many decades presented the greatest hazard to young children. In the two and a half decades since I gave that presentation abatement activities have substantially reduced the amount of hazardous lead-based paint found on residential dwellings across the United States.
Just to give a little background, I spent my first 12 years in public health directing the City of St. Louis Lead Poisoning Prevention program. After moving on to become the City's Deputy Health Commissioner with operational responsibility for all public health programs in St. Louis (including lead poisoning prevention and treatment), I continued to be active professionally on a local, state and national level with childhood lead poisoning prevention. This active involvement included serving as a consultant member of the Centers for Disease Control (CDC) Advisory Committee on Childhood Lead Poisoning Prevention which produced the 1991 guidance publication, "Preventing Lead Poisoning in Young Children. Although later guidance has, to some extent, superseded the 1991 statement it is still maintained by the CDC here.
This committee also developed the later 1997 guidance publication, "Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials". This is still the current recommendation for officials. That publication is available here.
We also worked with CDC to on two studies which were later published and then used and referenced extensively in the development of public policy designed to the eliminate childhood lead poisoning. Abstracts of these two Journal publications are linked below. The first related to evidence of paint chip ingestion found in X-rays of the abdomen of children suffering from lead poisoning and it can be found here.
A second and very widely cited study on the effectiveness of the standard lead-paint abatement methods can be found here.
For current information on what is happening in the fight against childhood lead poisoning go to the CDC lead pages from this link.
Lead-poisoning has been known and documented for thousands of years. Childhood lead poisoning was first scientifically studied and documented in Australia in the late 1800's. If you are interested in learning more of the history of lead and lead poisoning, including what Charles Dickens and Benjamin Franklin had to say about it, try this link.
Read the actual (short and very interesting) Benjamin Franklin "Lead Letter" by following this link.
Paint is still a very real hazard in pre-1950's housing when it is in serious disrepair and when old paint has not been removed or permanently covered. These conditions are mostly found in older housing in urban areas. Soil and dust contaminated with lead from old paint is also a significant problem in these areas. In St. Charles County, only a small proportion of housing was built prior to 1950 when highly leaded paint was manufactured and most of the older housing in our county has been well-maintained and usually contains little remaining lead-based paint.
As a public health department we don't have to guess about whether we have a problem with childhood lead poisoning in our county. Each month the State of Missouri Department of Health and Senior Services (DHSS) sends a detailed report on children tested for lead poisoning in every county in Missouri. In the most recent report for June, 2006, 167 children in St. Charles County were screened and none were found to have elevated lead levels. In fact, all of the June blood lead levels reported in St. Charles County children were very low. This is typical of children tested throughout the year in our county. It demonstrates that our housing stock is newer and that older dwellings are well-maintained. It also demonstrates that soil contamination is not significant in our county. St. Charles County is designated by DHSS, using federal CDC guidelines in the guidance document for state and local public health officials cited above, as a "low risk county".
Does this mean that there is no risk of lead poisoning for St. Charles County children? No, it does not! Although the risk is very low we do from time to time find a child with an elevated lead level. In almost all cases when a cause can be identified it falls in on of the two following categories:
- The child has spent a significant time living in a older home outside of St. Charles County or recently moved to St. Charles County after residing in an older home elsewhere;
- The child lived in one of the older homes in St. Charles County when that dwelling was rehabbed or remodeled. The release of lead dust, fumes and possibly the presence of chips of paint are the probable cause of the elevated lead level.
Lead is naturally eliminated from the body. If an elevation in lead level is caught early, removal of the source of lead or temporary relocation of the child allows the body to lower any harmful lead level by eliminating lead from the body. In more serious cases with higher lead levels treatment with one of several drugs will help to eliminate the lead. It is far better to prevent an elevated level in the first place. If not prevented, some children will suffer temporary impairment from an elevated lead level. With higher levels some children will suffer permanent mild to severe injury.
In addition to the two situations described above, it is important for all parents to be aware of other possible sources of lead. Many of you reading this have heard news media reports from time to time warning about some of these products and sources. Most recently some types of Mexican candy have been found to have unacceptable levels of lead in the candy wrapper which may allow absorption of lead into the candy. Other news reports have cited Reebok charm bracelets, other inexpensive metal toy jewelry for children sold in vending machines, some Asian and Mexican folk medicines, imported crayons and some window miniblinds. Poorly glazed pottery that allows lead to be leached out of the glaze when an acidic beverage, such as orange juice, is served in the container has historically been a problem. Safe Kids USA maintains a list of all child related recent recalls, including lead related recalls. You can find the Safe Kids USA website here.
The Federal Consumer Product Safety Commission also has a website that lists recalls. It also has an "Especially for Kids" section. It can be found here:
Finally, some adult hobbies can pose a lead poisoning risk to children as well as adults. Some that have been documented in the past include:
- loading shotgun shells with lead shot (lead dust or the ingestion of lead pellets)
- melting lead to make lead fishing sinkers (lead fumes and lead dust and ingesting lead)
- firing pottery with in a home kiln with lead glaze (lead fumes)
- making lead toy soldiers (lead fumes) or playing with older lead soldiers (putting toy in the mouth - this is definitely an ADULT collectors hobby)
- Solder and lead used in the making of stained glass art. (fumes and ingestion of pieces of lead)
I certainly don't mean to suggest that these hobbies are inherently bad. They are not. But in all the cases cited above (with the exception of lead fishing weights) taking proper precautions for ventilation, avoiding leaded glazes when making pottery, keeping lead collectibles locked up and out of a child's reach, following all safety recommendations when making stained glass pieces, and having a work area that is dedicated to the particular hobby and not accessible to young children all will prevent child and adult lead exposure. About those lead sinkers; melting lead in a home or garage is never a good idea!
Finally, I hope that you have found this month's much longer than usual "From the Director" interesting (Did you read the Benjamin Franklin letter?). I am including some more links to information below. I hope you will find them informative. Lead poisoning is a totally preventable and potentially devastating childhood disease. If you know how it happens you can prevent it.
Missouri Department of Health and Senior Services Lead Pages:
www.dhss.mo.gov/ChildhoodLead/
U.S. Department of Housing and Urban Development
www.hud.gov/offices/lead/index.cfm
National Center for Healthy Housing - Lead Links Page
www.centerforhealthyhousing.org/html/lead_links_page.html
City of St. Louis - Annual Lead Reports
http://stlouis.missouri.org/citygov/health/documents.html