Last January, we were stunned as we watched the city of Flint, Michigan, and the rest of the nation, react to the poisoning of its youth from lead leaching into the drinking water. In a five-part series on The PediaBlog (starting here), we considered why growing children are more likely to be exposed to lead than adults:
Children are especially prone to lead poisoning because they like to play in dirt that, unbeknownst to them, may be contaminated with lead. They are also less inclined to wash their hands before putting their fingers, toys, debris (ie. paint chips), and food in their mouths. For those reasons — and because children breathe more air and drink more water per unit volume compared to adults — they are at highest risk of exposure to lead and other environmental toxics.
We learned how lead finds its way into the brains and other organs of children, with profound consequences:
Lead acts very much like calcium in the bloodstream, so it tends to build up in bone. Children’s growing bones are metabolically active to the extreme, so lead doesn’t stay there for long. Instead, it travels to other metabolically active and growing organs, particularly the brain. It is here that lead, a natural heavy metal, can do the most unnatural damage.
The injuries caused by lead in a developing child’s brain may be profound, or they may be subtle, but they are always permanent. We know that brain damage from lead causes lower IQ’s and other cognitive delays, learning disabilities, hearing impairments, difficulties with attention and concentration (ADHD), decreased academic achievement, and anti-social and other behavioral problems. All these effects have life-long consequences for children when they become adults, and for the rest of society.
Children experience other health effects when they are poisoned with lead. Kidney damage and anemia, short stature and pubertal delays, peripheral nerve damage and muscle weakness all can result in chronic and often painful, lifelong sickness and disability, and early death.
We listened when one of the heroes of this story, Flint’s own pediatrician Dr. Mona Hanna-Attisha said:
“When you detect (lead) in a kid … that means primary prevention has failed. And that’s what we need to be doing for lead: primary prevention. It should never reach a child.”
Recognizing that there are no safe levels of exposure to lead, cities around the country started to question their own water quality. In Pennsylvania, Governor Wolf and the Department of Health are advocating for universal, mandatory lead testing in all children at 12-months and 24-months of age. Alex Davis says the proposal comes on the heels of a recent study comparing children’s blood lead levels in each state which ranked Pennsylvania second to last:
The proposal comes after a recently released study, “Blood Lead Levels in Young Children: US, 2009-2015,” that puts Pennsylvania as the second state with the highest proportion of high blood lead levels at 7.8 percent, behind Minnesota with 10.4 percent.
Last month, the American Academy of Pediatrics made several recommendations to the government, public health officials, pediatricians, and other health care providers for the Prevention of Childhood Lead Toxicity. Universal mandatory blood testing wasn’t one of them:
The key to preventing lead toxicity in children is identification and elimination of the major sources of lead exposure. Primary prevention of lead exposure is now widely recognized as the optimal strategy because of the irreversible effects of low-level lead toxicity. The primary prevention approach contrasts with practices and policies that too often have relied predominantly on detection of lead exposure only after children develop elevated blood lead concentrations.
Jill Daly reports that the AAP’s Council on Environmental Health (disclosure: I am a member) is calling for “stricter regulations and expanded federal resources”:
In particular it is pushing for new federal standards defining and testing for lead hazards in house dust, water and soil. In addition, it urges legal requirements that lead be removed from contaminated housing and child care facilities. Water fountains in schools also should not exceed water lead concentrations of more than 1 part per billion.
Tomorrow, we’ll have a look at what the Pittsburgh region is doing to prevent lead poisoning in children.