
Lead poisoning in children: its causes, effects and prevention
Transcript
Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. One of the worst lead poisoning crises in America is here in Syracuse, where the Onondaga County Health Department reports up to one in five children in some of the lowest income neighborhoods have elevated levels of lead in their blood. Here with me to talk about this problem is the pediatrician who cares for many of the children who are lead poisoned. Dr. Travis Hobart is an assistant professor of pediatrics and of public health and preventative medicine at Upstate. And he's also the medical director of the Central and Eastern New York Lead Poisoning Resource Center. Welcome back to The Informed Patient, Dr. Hobart.
Travis Hobart, MD: Thank you so much for having me. I'm glad to be here.
Host Amber Smith: I'd like to start by asking you to explain why lead is dangerous.
Travis Hobart, MD: Lead is dangerous because it has multiple effects on the body. Most importantly, it affects the brain and the nervous system, and that is particularly true for children who are more likely to be exposed and adults, for a number of reasons. And in children when they are exposed, it has permanent effects on their on their brain and development. It can lower their IQ. It can affect their behavior and attention, which gives them trouble in school as they go forward, as they grow older. And it affects their executive function. So it affects people's ability to make good decisions, which is obviously crucial to succeeding in life.
Host Amber Smith: Is it inhaled, or is it ingested?
Travis Hobart, MD: So it can be, it can be either. Most typically for kids, they are ingesting it in their mouth. And the way that that happens is usually that -- most often, anyway, the way that it happens is that -- the paint in older homes may still have lead in it, and as the paint deteriorates, dust from the paint falls onto the floor. And as we all know, children crawl around on the floor, and children often put objects in their mouth that may have that dust on them. And so they usually get it that way, by putting objects or putting their hands in their mouth that have leaded paint dust on them, and they ingest it that way. That said, it can also be inhaled into the lungs and absorbed that way. For instance, we sometimes will see that happen where somebody is doing home renovations, and they're sanding down old paint. And that sanding process, puts a lot of lead dust into the air, and people then walk through the cloud of lead dust, or children are in the room and they inhale it that way. Or adults are in the room, for that matter, and inhale it that way.
Unfortunately we sometimes see that when people are pregnant and they're renovating a room for a new child, or re painting, or something like that. And so then not only does the older child might get exposed, but also the mother, the pregnant mother can be exposed too.
Host Amber Smith: So if the pregnant mother is exposed, can she pass that onto the developing baby?
Travis Hobart, MD: She can. Yes, unfortunately, the lead does pass through the placenta into the developing baby. And usually the fetus doesn't have quite as high a level as the mother does, but it's usually 85 or 90% of what the mother's level is. So definitely. And that can have effects on the pregnancy, that can lead to miscarriage and hypertension, high blood pressure during the pregnancy. And then it also can,when the baby is born, the baby can have a high lead level then, as well.
Host Amber Smith: You talked about the long-term effects and the permanent damage that lead poisoning can do. Are there immediate effects? Are there symptoms that a parent would look for to tell whether their child has been exposed?
Travis Hobart, MD: Sometimes, but I would say most of the time, what we see most kids who have an elevated lead level don't have symptoms at the time that we see them, because if you get a high enough level, it can cause things as bad as seizures and what we call encephalopathy, which is brain swelling and brain problems, along with those seizures, and it even can cause death in some cases. But that's very rare. Most of the time, at lower levels, the most common symptoms that it can cause would be things like constipation or abdominal pain, things which, while maybe a problem, are not exclusive to lead poisoning. And many children that we see in everyday practice have abdominal pain or constipation. And so, it's really hard to pick out a child who has lead poisoning based on symptoms alone. And for that reason, and maybe I'm getting ahead of, to another question you're going to ask, but for that reason we would recommend that everybody get tested, all the kids get tested at age one and two. And that's what the state requirements are, in New York state, that all kids, age one and two, get tested, and that pediatricians are asking these questions when kids are from six months to six years old, asking the questions, "Hey, do you live in an old home? Do you have paint that's breaking down or flaking off?" and other questions that might be a warning sign for a kid that might get exposed.
Host Amber Smith: So it sounds like you generally discover this through the blood test, the routine blood tests?
Travis Hobart, MD: Yeah, that's correct. Yeah. Most of the time we don't know until we do the blood test.
Host Amber Smith: Okay. Why is the lead poisoning such a problem in Syracuse?
Travis Hobart, MD: So the main reason that it's a problem in Syracuse, and I don't want it to be exclusive to Syracuse. Unfortunately it's a problem in many, many cities in the Northeast and the Midwest. And the reason for that is that our housing is very old as a whole. If you look at the housing in the city of Syracuse, about 90% of it is built before 1980. And the reason that that timeframe is important is because lead paint used to be used regularly inside homes in residential for residential use, but that was banned in 1978. So if your house was built from 1978 onwards, then it was not, lead paint was never used inside your home. But if your house was built before then, which as I said, about 90% of the houses in Syracuse were there may well have been lead paint in there. It doesn't guarantee it, but, it makes it more likely. And the older your home is, the more likely it is that lead paint was used.
Host Amber Smith: So if you live in an old home, it's probably been painted since then, probably many times, but maybe the lead paint, the original lead paint, maybe wasn't removed. So would it still potentially pose problems?
Travis Hobart, MD: So we know that a painting over the lead paint does contain it in the wall. And so fortunately, if you live in an old home and the paint on your walls is in good shape, and it's not flaking off or breaking down, then you're in good shape. But the problem is, is that we know that that's not always the case, that sometimes the paint is breaking down. And in particular, we know that when people are renting homes, they often don't have the control over the paint that the landlord does. And unfortunately there are landlords out there that aren't responsive to tenants' needs. So, if they're not painting regularly and keeping the paint in good shape, then that old paint comes through, and we end up with kids being exposed. And then another place that sometimes we see the paint breakdown, more often, I should say, is in doors and windows. And that's because they have moving parts. And so as the doors are opened and closed, as the windows are opened and closed, the paint gradually breaks down, the layers get worn away, and you get to some of that older paint. And windows in particular, if you have a very old window, it usually has a storm window, the old sort of I think -- I forget what they're called -- but the old windows that have a storm window and then a main window. And that in-between area, while people may paint the inside of the window and people made the outside of the window, they aren't always painting that in-between area. And so, that's okay as long as the window's closed. But if it's a hot summer day and you open the window, then that paint that might've deteriorated in there might come into the home.
If you're living in a home that might have old lead paint, couple of things that you can do for your family and for your children: One thing is making sure your child is getting good nutrition, because if they have enough iron and enough calcium and enough vitamin C in their system, then they will absorb less lead from their environment. So I think it's important to make sure they're getting good nutrition. If you're afraid that they're not eating well or something like that, certainly talk to their doctor, or maybe consider using a multivitamin with your doctor's advice and approval. So I think that's an important aspect of prevention.
And then the other thing that I would recommend for families to do is: if you think that there's lead paint in your home, it's important when you're cleaning to do it with a mop or a wet wipe rather than a broom, because if you sweep up the lead dust, it just kicks it up into the air, and then it resettles down on the floor. And so the important thing is to mop it up or wipe it with a wet wipe so that you're getting it out of the environment and keeping your kids from being exposed.
Host Amber Smith: And we've talked about Syracuse and cities, but is this the problem in rural or suburban areas as well, or potentially?
Travis Hobart, MD: It is. Yeah. And we do have children every year that are exposed in suburban and rural areas as well. So anywhere where there's an old house, it's true. Now typically, the suburban areas have usually a lower percentage of older housing because they've been built up in the last 50 years or 40 years, but that's not to say there's none. I live in a suburban area, and my home has even old windows that have lead in it that I know for a fact. The rural areas, in particular, when we do sometimes see kids that come that live in a farmhouse or something like that, that's been around for a hundred and 150 years, and they often will have lead paint in those places too. I think the difference is, is that, of course, in the city, more people live in the city, so we often see higher numbers there, and also more people usually rent homes in the city where, again, they have that lack of ability to make the repairs that are needed to keep the house up to date.
Host Amber Smith: What can you tell us about the lead abatement and control ordinance that the city of Syracuse passed a couple of years ago? Has it been helpful?
Travis Hobart, MD: So, yes. I'm very hopeful about that lead ordinance. I think it's on route to being helpful, let's say. What the ordinance does, is it requires that homes are inspected, I believe it's every three years, that rental homes are inspected every three years and that they're on the rental registry, so that we are sure that if there's a lead issue that comes up, that that gets identified in that three-year period, and the landlords are then responsible for fixing it. And so that's great. And that's the kind of model that has been done in other cities as well, a similar models to that of making sure that these houses, these rental homes get inspected regularly to protect the children that might live there. And why I say it's en route to becoming effective is, it was passed during the pandemic, of course. And so the city is still in the process of operationalizing it and enforcing it. And so that required that they hired more inspectors, and it required that they had money to do it. And certainly early in the pandemic, they were very low on money. And then in the last year they got some money from the federal government. So very recently I've heard that they are moving forward with getting that ordinance done and operationalized so that they can enforce it and really make it work for the families in the city.
Host Amber Smith: Is there any way, right now, for a potential tenant to know ahead of time if the apartment that they're thinking about moving into is a lead hazard?
Travis Hobart, MD: There are a couple of ways that it might come up. When you're buying a house, the previous owner is supposed to disclose if there are any lead hazards in the home. So that's at least something. It usually isn't the greatest because some people don't always know that there are lead hazards in the home, even though there are. Now if you're renting a house, you can, I believe you can ask for an inspection, but I don't know the exact rules on whether the landlord has to get the inspection done, or not, before they give it to you. I mean, now this new ordinance says that they would have had to have one within the past three years. But again, I'm not sure. It may be that they haven't because it's yet to be really enforced. But you can certainly ask for them to do an inspection and look for lead.
And then, if you live in a home where let's say you're already renting a home, if you have a child or you're pregnant, you can call the health department, and the health department can do an inspection for looking for lead, specifically. And now I should say that they will do the inspection for people that ask, but they have to prioritize the places where people have been exposed already. And for a number of reasons, including the pandemic, obviously, there's a pretty good backlog of people needing inspections, for that reason, that already have lead poisoning, and the health department has to prioritize those. So if you call out of the blue, they may not be able to come right away to do the inspection.
And then finally, what I would say is that, I wish there were an easier way to find out if your house had lead in it then than that, and we're headed in that direction. So that's encouraging. And the other thing that I would say is that you can do it yourself, to some degree. So there are lead testing kits that are available at Home Depot or Lowe's or whatever hardware stores that are little pieces, like little cylinders that have fluid in them and you pop it and then you rub it on the area that you think there might be lead, and it will turn red if there's lead. And those are pretty accurate ways of determining if there's lead in certain places.
Host Amber Smith: Well, let me ask you as a practicing pediatrician who cares for children who have been lead poisoned, what is the treatment? What are you able to offer for medical treatment?
Travis Hobart, MD: I think maybe another unfortunate thing about it is that there are not treatment options for kids at low levels of lead. The medications that we use for lead poisoning are only really effective when the level is 45 or above, and so that's obviously way higher than what is unhealthy. And any level above zero is unhealthy. But the medications just don't work unless, the medications that we have, I should say, don't work unless it's 45 or above, and unfortunately I don't know of any pharmaceutical companies making medicines that would work. So the main therapy that we would do is fixing the hazard. That's the main thing that we can do is fixing the hazard in the home, and / or removing the child from the home so that they're no longer exposed. And so that, in some cases, might mean that they move to a relative's house or for a period of time, or in some cases it might mean that the whole family gets new housingthrough housing assistance or their own other way.
The key, sort of, treatment, quote, unquote, treatment of lead poisoning is not treating the kids after they become exposed. It's treating the homes before the kids are living there to be exposed in the first place. And so I think that's why part of my job is to talk to the health department regularly and talk to the city inspectors and, be a voice between the medical community and these public health organizations and public health agencies that are doing the work to keep kids out of these homes. That's what we call primary prevention. We'd rather keep the kid from being exposed to begin with because once we find it in the office, it's too late. They've already been exposed. Some of that damage has already been done. Now, we can prevent further damage, but we can't go back and erase the damage that's already been.
Host Amber Smith: Well, Dr. Hobart, thank you so much for making time for this interview.
Travis Hobart, MD: Yeah, no, it's my pleasure. I'm happy to do it. And thank you for inviting me.
Host Amber Smith: My guest has been Dr. Travis Hobart, a pediatrician at Upstate and also the medical director of the Central and Eastern New York Lead Poisoning Resource Center. The Informed Patient is a podcast covering health, science and medicine brought to you by Upstate Medical University in Syracuse, New York. Find our archive of previous episodes at upstate.edu/informed. I'm your host, Amber Smith, thanking you for listening.