When we talk about protecting our kids, the conversations range from water and fire safety to washing hands and staying healthy. Parents and some providers may not realize that a less obvious danger exists: lead poisoning. It makes kids sick, and it’s more common than you may think.
Lead: Exposing a Threat
Lead-based paint is found mostly in homes built before 1978. In fact, Pennsylvania has some of the most housing units in the nation built before 1950. Lead paint can deteriorate and create dust that settles on floors, windows, door jambs, and stairs.
Steps taken during the last two decades have reduced exposure to lead in tap water. But lead in the water can come from lead service lines that connect a home to the main water line. Pittsburgh, Harrisburg, Philadelphia, Reading, Lancaster, Altoona, and State College are among the 18 Pennsylvania cities with higher lead level exposures than Flint, Mich., which captured national headlines for its lead water crisis in 2015.
“The common response I hear from both the public and health professionals is, ‘Lead poisoning? Is that even still around?’ As long as you see older homes, you will always see lead poisoning in children,” says Joyce A. Ravinskas, BSN, RN, manager, Lead Poisoning Prevention and Education Program (LPPEP) at UPMC in Central Pa.
A History of Helping Kids
In the mid-1990s, the Centers for Disease Control (CDC) gave several states the funds to develop, implement, and evaluate lead poisoning prevention activities. UPMC in Central Pa. (formerly Pinnacle Health Hospital) was selected to implement the Centers for Disease Control and Prevention’s Childhood Lead Poisoning Prevention Program for south central and northeast Pennsylvania.
“Children were referred to the program from doctor offices, and our phlebotomists went door to door in high-risk areas to test children for lead poisoning,” Joyce says. The team also tested children at Women, Infants, and Children (WIC) offices and Head Start programs.
For the past 15 years, Joyce has managed the LPPEP program in Harrisburg and at satellite sites in Lancaster, Reading, and Wilkes-Barre. “Lead poisoning is irreversible. Children who are poisoned at a young age have health consequences that will last a lifetime, so it is important we find its sources and stop its effects. Above all, our goal is to prevent lead exposure in children,” Joyce says.
The Effects of Lead Poisoning
According to medical experts, children 7 years old and younger are most vulnerable to lead poisoning. When lead enters the body, it prevents the cells from delivering oxygen to vital organs and tissues. It also causes anemia, a low red blood cell count. Lead poisoning interferes with all aspects of a child’s health — physical, behavioral, emotional, and cognitive — and possible developmental delays which can lead to future health care needs.
Most pediatric patients with lead poisoning show no symptoms. That’s why screening is so important. In Pennsylvania, there is no requirement for most children to be tested. The Early and Periodic Screening, Diagnosis and Treatment program does require providers to test children who receive Medical Assistance twice by age 24 months.
The American Academy of Pediatrics recommends lead screenings as part of routine well-child visits at ages 9 months through 12 months and again at age 24 months. In addition, any child between the ages of 24 and 72 months with no record of a previous lead screening test should be screened for lead poisoning, says Johanna Vidal-Phelan, MD, MBA, FAAP, senior medical director of quality and pediatrics at UPMC Health Plan and a pediatrician in clinical practice.
The good news is lead poisoning is the number one preventable environmental illness. Dr. Vidal-Phelan, a longtime supporter of the LPPEP, says lead poisoning is also an area of significant health disparities. Black and Latino children had higher percentages of elevated lead levels in their blood than non-Latino White children.
“If our program can halt the progression, or prevent childhood lead poisoning, it benefits everyone. I am proud of our work, and we will stop at nothing to help eliminate and control lead poisoning in all demographics,” says Joyce.
Sources and Solutions
Any disturbance of lead in a window, wall, or door will create lead dust. Lead remediation and abatement are very expensive and must be conducted by an EPA certified contractor. Often, a family will move out, and another family will move in without knowledge of lead in the home. Joyce notes that, if not properly addressed, this can result in more lead poisonings, underscoring the need for community education and resources.
Handheld analyzers are an important method used in detecting lead in homes. Determining if a home contains lead, and how much, begins with using an x-ray fluorescence (XRF) analyzer. Lead dust wipes are used on the windowsills and floors of several key rooms. The XRF analyzer information is downloaded into a computer program to generate the report and the dust wipes are sent to a certified lead lab.
Once all information is received, UPMC lead risk assessors determine the source of lead poisoning. The XRF information is sent via a report with recommendations to parents, the landlord and primary care providers, the codes enforcement department, and the state health nurse.
“I tell the parents to be vigilant and do what they can to create barriers and keep the home surfaces clean. These measures will keep the child from getting more lead in their bodies,” says Joyce.
A Future Free of Lead
Joyce is pushing for legislation to increase lead screenings and secure funding for lead removal throughout the state. Others are taking the opportunity to make changes, too.
In August 2019, Gov. Tom Wolf launched the Lead-Free PA Initiative, which seeks to expand access to blood lead level testing for children, increase local response efforts, and train more certified lead abatement professionals. Pittsburgh has higher testing rates since Allegheny County started mandatory blood lead testing for children between ages 9 and 12 months and again at 24 months.
The LPPEP provides support and guidance across its 15-county region. Lead presentations and courses help educate UPMC employees about the importance of a lead risk assessment. Health care, diet, and prevention tips, and other resources — including a toolkit — are available to providers and the community. For information about the LPPEP, visit UPMC.com/CentralPa.
“We’re all child advocates and believe everyone deserves the best start in life. Thanks to this program and pediatricians like Dr. Vidal-Phelan, we’re making strides to raise awareness about lead poisoning and grow our efforts to keep kids healthy in Pennsylvania,” says Joyce.