What you need to know about Lead Exposure and Prevention

 

There is no safe thing as a safe blood lead level. Unfortunately in our current world, many of us live in environments where our kids are not completely in the clear from 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 past and current. For the first time in 10 years the CDC has reduced the Blood lead reference value to 3.5 ug/dl. When I first started working at Noe Valley Pediatrics that reference number was 10. In 2012 it was lowered to 5. Now, for the first time in 10 years the CDC has reduced the blood lead reference value once again. Now it is 3.5 ug/dl. This means when your child gets a lead result, if it comes back any higher than 3.5 it will trigger some attention and hopefully resources to help you deal with it. Knowledge is power. It is absolutely worth getting your child tested. It is standard for pediatricians to order a blood test at either the 9 month, 12 month or 15 month exam depending on the circumstances. If there are obvious hazards they may order the test at the earlier visit. Since your baby is already going to get poked, I suggest asking them to couple the lead test with a routine CBC (complete blood count) that also measures the iron level. As you well know, things can get sidetracked during your little one's well child exam. There are so many things to talk about and sometimes 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 of getting a blood test, feel free to remind them. If they don’t do the testing in the office, you should find out which laboratories are preferred by your specific insurance plan. Although they are not always in network, the hospital labs facilities are often more adept and drawing blood from the younger patients. If there is any lead showing up, you want to figure out where it is coming from and make sure you keep that level from getting higher. In San Francisco, if your child 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. Be aware that when a lab finds an elevated level, it is legally required to report all positive tests to the health department. 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 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 their unborn babies. Lead poisoning affects learning and behavior, damages organs, causes dental cavities, decreases hearing and decreases intelligence. Lead Paint In 1979 lead based paint was banned from use in house paint. That is well and good, but the 2015 census claimed that 83% of houses in San Francisco were built before that law went into effect. It is possible that that statistic has changed with all the new neighborhoods popping up, but the fact is, the majority of our kids are growing up in older homes. If you do have an older house with any peeling paint, make sure that cribs and highchairs are moved away from walls. There are some home testing kits that check paint for lead, but they are often misused. The easiest way to test paint is to check the paint that is 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. It is okay to do a small test, but try not to disturb paint in old buildings yourself. This is one of those cases where it is best to hire a professional. A list of Lead certified professionals is available by calling 1-800-597-5323 or clicking on the link. Lead in the water Lead in the water can be a concern. It is worth finding out if your water sources are safe! This is especially critical If you have a baby getting formula that is mixed with tap water. Check your pipes right away. Don’t wait until your child gets a routine lead test to find out if there is an issue. According to the very helpful Childhood Lead Prevention Program here in SF, new brass fixtures can actually be as much of a problem as the old pipes because they can give someone a false sense of security. Even if the new fixtures claim to be lead free, it is still possible for some lead to get into the water from the 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. You can use the initial water for watering plants. This link has good information about our local water and testing. If you want to 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. There are also some products for testing water available from Amazon, but as is the case with most things, It is important to read reviews carefully. If you are not lucky enough to live in a place with safe water, consider getting a filter that is tested to remove contaminants. Boiling water will NOT remove lead. If your child is getting only filtered water, make sure that they are getting necessary fluoride. Other Common Sources of Lead: Paint and pipes and water are only a couple of the many ways in which kids can 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. 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 or www.cpsc.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. Make sure you are buying things directly from a trusted source. If you buy something online, it isn’t always clear where it is actually from.  If you notice that your child is putting a toy in their mouth frequently and you're not absolutely sure it's lead-free, get rid of it and find something safe to take its place. Of course it is always important to make sure that your child is playing with age-appropriate toys that they are not at risk of swallowing. Children arts and craft products - some products have been recalled due to the violation of paint standards. Look for the label Meets ASTM D-4236 to make sure they are safe Coatings, jewelry and decals on some imported children's clothing 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. Always grow vegetables and fruit in raised beds with OMRI(organic material review institute) certified Lead Free soil available at the hardware stores.  Ayurvedic medicine Imported beads or necklace  Pre 1997 imported vinyl blinds Prevention is the best defense! A nutritious diet is VERY important and should be considered a first line of defense. Lead in the body is distributed to, and absorbed by, the brain, liver, kidneys and bones. A healthy, low-fat diet rich in iron, vitamin C and calcium reduces the body’s ability to absorb lead. Lead actually binds to these critical nutrients and is eliminated instead of being absorbed by the body’s organs and bones. Having regular meals and snacks can also be protective since lead can have more opportunity to absorb on an empty stomach. Iron Iron deficiency increases absorption of lead from the stomach and intestines. Good sources of iron are: · Iron-fortified cereals · Green leafy vegetables · Pureed meats · Lean red meats · Tuna, salmon, fish · Raisins, dates, and prunes · Dried beans and peas · Skinless poultry · Nuts or sunflower seeds Vitamin C Vitamin C and iron rich foods work together to reduce lead absorption. Good sources of vitamin C include: · Oranges and tangerines · Grapefruit · Limes and lemons · Strawberries · Cantaloupe · Kiwi · Potatoes and sweet potatoes · Tomatoes · Broccoli · Bell peppers Calcium Calcium reduces lead absorption and also helps to build strong bones and teeth. Foods that are good sources of calcium are: · Milk and milk products · Cheese and yogurt · Green leafy vegetables · Calcium-enriched orange juice · Tofu · Salmon · Peanuts If you notice that your child is not growing out of the "everything in the mouth" phase and is constantly putting non food items in the mouth, it is worth bringing this up to the doctor. This can be the sign of an elevated lead level. 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 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 or speak with the Public Health nurse. Call 311 or visit www.sfdph.org/dph/eh/cehp/lead Thank you to the very helpful folks at the Children's Environmental Health Promotion Program at the San Francisco Department of Public Health for their input on this post.