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Safety & Prevention

During the first two to three years of life, your child goes through a phase of putting things other than food into his mouth. He’ll chew on his toys, taste the sand in the playground, and sample the cat’s food if given the opportunity. As annoying as this behavior can be, few of these things will cause him any serious harm, as long as you keep poisons and sharp objects out of his reach. Lead is one dangerous substance, however, that your child can consume without your knowledge.

Contrary to popular belief, lead poisoning is not caused by chewing on a pencil or being stabbed with its point. The so-called lead in a pencil actually is harmless graphite, and there is no lead in the paint coating the outside. Lead poisoning is caused most often by eating lead contained in dust, bits of old paint or dirt, by breathing lead in the air, or by drinking water from pipes lined or soldered with lead. There also may be lead in hobby materials such as stained glass, paints, solders, and fishing weights. It might be in mini-blinds manufactured outside the United States prior to July 1997. If you buy new mini-blinds, look for those that have a label that says “new formulation” or “nonleaded formula.” Lead also might be in food cooked or stored in some imported ceramic dishes. Do not serve acidic substances (e.g., orange juice) in these dishes, since the acids can leach lead from the dishes into the food. Although food cans with soldered seams could add lead to the food inside them, these cans generally have been replaced by seamless aluminum containers in the United States.

Lead was an allowable ingredient in house paint before 1978 and so may be on the walls, doorjambs, and window frames on many older homes. As the paint ages, it chips, peels, and comes off in the form of dust. Toddlers may be tempted by such bite-size pieces and will taste or eat them out of curiosity. Even if they don’t intentionally eat the material, the dust can get on their hands and into their food. Sometimes the lead containing finish has been covered with other layers of newer, safer paints. This can give you a false sense of reassurance, however, since the un derlying paint still may chip or peel off with the newer layers and fall into the hands of toddlers. Although there has been a decline in high lead levels in children’s blood, somewhere between half a million and one million children in the United States still have unacceptably high levels. Living in a city, being poor, and being African American or Hispanic are all risk factors that increase the chances of having an elevated bloodlead level. But even children living in rural areas or who are in well-to-do families still can be at risk.

As a child continues consuming lead, it accumulates in the body. Although it may not be noticeable for some time, ultimately it can affect many areas of the body, including the brain. Lead poisoning can cause learning disabilities and behavioral problems. Very high levels will likely cause the most severe problems, but the extent of damage for any individual child cannot be predicted. Lead also can cause stomach and intestinal problems, loss of appetite, anemia, headaches, constipation, hearing loss, and even short stature. Iron deficiency increases the risk for lead poisoning in children, which is why these two disorders are often found together in children.

Prevention

If your home was built after 1977, when federal regulations restricted the amount of lead in paint, the risk for having dangerous amounts of lead in the dust, paint, or soil of your residence is low. However, if your home is older, the likelihood of having dangerous amounts of lead there can be very high, especially for the oldest homes (those built before 1960). If you think your home may contain lead, clean up any paint dust or chips using water. During this cleanup, if you add a detergent to the water, it will help bind the lead into the water. Also, keeping surfaces (floors, window areas, porches, etc.) clean may lower your child’s chance of being exposed to lead-containing dust. Older windows are of particular concern since paint on wood frames frequently is damaged and the action of opening and closing windows can produce leadcontaining dust. Do not vacuum the chips or dust as the vacuum will spread the dust out through its exhaust hole. It’s also a good idea to have your child wash his hands often, particularly before he eats.

Another step is to identify surfaces in your home with lead contaminated paint, or areas with dangerous amounts of lead in the dust or dirt. A home inspection is necessary to do this, and you can get help from your local or state health department to find a lead inspector in your area. Sometimes, health departments will provide the inspection themselves, but most often you will have to pay for it.

If you live in an older home that needs repairs, you should assume that the repair process could potentially generate dangerous amounts of lead dust. So unless you know positively that any paint that will be disturbed does not contain lead, you need to seek expert advice before starting repairs. Renovation projects that disturb lead paint need to be done by individuals with special training in lead-safe work practices. Sanding and scraping of paint can generate large amounts of dust, and exposure to this dust during or following renovation is a common way that children get lead poisoning. The safest approach is for the family to move out while the renovation is ongoing and until the final cleaning has been completed. Contact your state or local health department for more detailed information.

Incidentally, in a rented home, the landlord is responsible for all maintenance, and this includes necessary repainting and repairs. If you suspect unhealthy lead levels in the building, and your landlord is unresponsive or is not using lead-safe work practices when doing repairs, ask your community’s health department for help. Sometimes legal actions can compel the landlord to make safe repairs.

Also, call your local health department, to see if lead in the water is a problem in your community. Or contact the Environmental Protection Agency’s Safe Drinking Water Hotline (1–800–426–4791) to find out whether your local water supply presents a risk of lead exposure.

Treatment

Children who have lead poisoning rarely show any physical symptoms. However, learning and behavior problems from lead may show up in the preschool child or may not show up until the child reaches school age. At that point they need to learn more complicated tasks like reading or arithmetic and may have trouble keeping up with class work. Some may even seem overly active, due to the effects of the lead. For this reason, the only sure way to know if your child has been exposed to excessive lead is to have him tested. A blood test for lead at ages one and two years is recommended for children at high risk for lead exposure. In communities where high blood lead risk is low, a series of questions will determine whether a blood test is necessary. Local and state health departments have developed guidelines based on the risks for their areas.

The most common screening test for lead poisoning uses a drop of blood from a finger prick. If the results of this test indicate that a child has been exposed to excessive lead, a second test will be done using a larger sample of blood obtained from a vein in the arm. This test is more accurate and can measure the precise amount of lead in the blood.

Children who have lead poisoning should immediately be moved from the home where they are being exposed to this toxic substance. In rare instances, they may require treatment with a drug that binds the lead in the blood and greatly increases the body’s ability to eliminate it. When treatment is necessary, usually oral medicines are used on an outpatient basis. Much less frequently, the treatment may involve hospitalization and a series of injections.

Some children with lead poisoning require more than one course of treatment. Unfortunately, standard treatments for lead-poisoned children produce only a short-term or marginal lowering of the child’s body lead levels and do not lower the child’s chance of developing lead-related behavioral or learning problems. Children who have had lead poisoning will need to have their physical health, behavior, and academic performance monitored for many years and should receive special schooling and therapy to help them overcome learning and behavior problems. The best treatment for lead poisoning is prevention.  

 

Last Updated
5/11/2013
Source
Caring for Your School-Age Child: Ages 5 to 12 (Copyright © 2004 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.