Friday, March 11, 2016

Lead Exposure (update)

Young children are much more likely to be exposed to lead hazards by touching lead-contaminated surfaces and then putting their hands in their mouths.  In addition, children's bodies absorb more lead than adult bodies do because they are still growing; but lead is a problem for all of us. Pregnant women need to be especially careful because any exposure can harm the unborn babies.

Recent media coverage of water quality issues in Flint, Michigan has brought concerns about lead contamination to many people’s consciousness.

The SF public Utility commission issued this statement on 2/1/2016:

The primary cause of the water quality concerns in Flint appears to have been a failure to maintain corrosion control – a basic principle of water delivery (after disinfection/treatment). In San Francisco, we have been a model utility in lead abatement for decades. All lead pipes and service lines were removed from the San Francisco retail service area over 2 decades ago. The San Francisco Water Department replaced more than 7000 lead service lines in the 1980s.
We discontinued the use of lead joints in our distribution system. We began lead monitoring in 1992 (in adherence with the Lead & Copper Rule, one of the US EPA’s National Primary Drinking Water Regulations.) Sometimes minor fittings or joints with some lead materials are discovered in older parts of our system; when discovered they are replaced. Our excellent corrosion control practices eliminate any exposure to these minor lead surfaces. San Francisco’s corrosion control practices are optimized to minimize the potential for lead contamination.

According to the very  helpful Karen at the Childhood Lead Prevention Program here in SF, new brass fixtures can actually be more of a problem than the old pipes. Even if the new fixtures claim to be lead free, it is possible for some lead to get into the water. It is important to  run the water for a moment to eliminate any water that had been stored in the pipes.

If you want to go the extra mile and get your water tested, in San Francisco, it is free for anyone on the WIC program. Contact the lead program for a voucher. For everyone else it is $25/tap. Click the link for directions :


There are also some products for testing water available from Amazon, but they have mixed reviews.

If you are not lucky enough to live in a place with safe water, consider getting a filter that is tested to remove lead. Boiling water will NOT remove lead.
Make sure that if your child is getting only filtered water that they are getting necessary flouride.

Pipes and water are only one of the many places where kids can possibly get exposed. Most of the lead gets into your child from the hand to mouth route. They either chew on something directly, or put hands that have been in contact with lead dust into their mouths.

Other Common Sources can include:

*paint chips. (House built before 1978 are most at risk)

pipes 
Only use cold water for cooking, drinking or making baby formula because hot water is more likely to contain higher lead levels. If you haven't used a faucet in the last six hours, flush it out for one to two minutes before drinking or cooking with it. The longer water has been sitting in the pipes, the more lead it can absorb. Use the initial water for watering plants or ......

*keys (don't let your child chew on them)

*Brightly painted pottery or toys 
Beware of things imported from different countries The brighter the color, the more apt they are to have lead. It's hard to be absolutely sure if a toy has lead in it or not. Start by checking www.recalls.gov to see if a specific toy has been recalled.

Be wary of cheaper toys -- like those from vending machines or street fairs -- and especially plastic jewelry. If you notice that your child is putting a toy in her mouth frequently and you're not absolutely sure it's lead-free, take it away. To lower the risks of poisoning, make sure that your child is playing with age-appropriate toys that he's not at risk of swallowing.

*Antique furniture varnish

*Varnish on bathtubs

*Some lipstick brands

*Some candies imported from other countries

*some computer cables (of course chewing on cables is not a good idea no matter what)

*Dirt and sand that get tracked in from outdoors

*urban gardening (increases contact with possibly contaminated soil)

*Ayurvedic medicine



*Pre 1997 imported vinyl blinds

Unfortunately in our current world, many of us live in environments where our kids are in fact getting some lead exposure. Lead does not break down or fade away with time. It remains in the environment and we are stuck dealing with bad habits from the past.

It is worth getting your child tested. In our office we usually suggest a blood test at either the 9 month, 12 month or 15 month exam depending on the circumstances (if there are obvious hazards we test on the earlier side.) I suggest coupling the lead test with a routine CBC (complete blood count) that also tests the iron level.
It is easy for everyone to get sidetracked at some of the the well child exams. There are so many things to talk about and sometime the kids are kicking up a bit of a ruckus towards the end of the visit. If the doctor doesn't bring up the subject off getting a blood test, feel free to remind them. 

When we get the lead results, the best news is <2 or undetectable. In past years the public health department's lead prevention program would get involved if the level was over 10 but as of 2016 the standards have changed. Now, NO measurable level is considered okay. If there is some lead showing up, we want to figure out where it is coming from and keep that level from getting higher. If your child in San Francisco has any elevated lead level the city will send out a public health nurse to help you explore your environment and see if they can figure out the source.

For reference a level over 45 is an urgent situation that needs treatment.

This link gives a full description of what the different levels signify:
Prevention is the best defense!

A nutritious diet is VERY important. Iron, calcium and Vitamin C compete with lead for absorption. Healthy eating should be considered a first line of defense.

Consider having a 'shoes off' policy to avoid tracking lead dust inside. This is especially important if someone in the household has routine lead exposure during their job; make sure they clean off well before having close contact with other family members.

Make sure your kids get in the habit of frequent hand washing, especially before meals and snacks

Do the best you can to make sure there are no obvious lead sources inside your home. Any home built prior to 1979 is at greater risk. If you have an older house with any peeling paint, make sure that cribs and high chairs are moved away from walls.

There are some home testing kits that check paint for lead, but they are often misused. The easiest paint to test is that on wood or varnish. In order to get an accurate result, you need to scratch the surface and mix the test liquid with more powdery paint. I don't have a favorite brand. 

If you have any concerns about your home, regardless of whether or not your child has been tested for lead, call the SF lead program to arrange a public health nurse visit. The easiest way is to call 311 and ask for the lead prevention program.

1 comment:

  1. Hi Nurse Judy, I was just in your solids food class and you mentioned checking out Osem, the manufacturer of the Bamba snacks. Pretty interesting - turns out Bamba is 63% owned by Nestle, and tomorrow the minority shareholders are voting whether to let Nestle also have the rest of the company -- "Expert opinion is divided on the wisdom of the proposed merger of the Osem and Nestle food companies, coming up for a shareholders’ vote on March 17, Globes said on Sunday." (http://hamodia.com/2016/03/13/consultants-mixed-nestle-osem-merger/)

    Thank you for a great class!

    ReplyDelete