Lead Poisoning (in Children)
Lead poisoning is completely preventable, yet it is one of the most common pediatric public health problems, particularly in the Northeast region. Exposure to lead can harm young children and babies, even before birth. Often, a child with lead poisoning shows no initial signs or symptoms, other than elevated levels of lead in his or her blood.
Yale Medicine’s Pediatric Lead Program specializes in treating children with lead poisoning. Our team, which sees patients at Yale New Haven Children’s Hospital Lead Poisoning and Regional Treatment Center, includes medical, social work and public health experts.
“Lead is a problem in many northeastern cities,” says Carl R. Baum, MD, director of the Pediatric Lead Program and a medical toxicologist. “And a majority of what we see comes from dust from old paint. The best-case scenario would be that families never move into those older homes with lead paint in the first place.”
What is lead poisoning?
Lead is a naturally occurring metal used in plumbing, construction materials, and car batteries. Long-term exposure to it can cause serious health problems, especially in children whose brains and nervous systems are still developing.
Lead is most harmful when it is inhaled or swallowed. It builds up in the body over a period of months or years. Once in the bloodstream, it can cause anemia, which decreases the oxygen-carrying capabilities of red blood cells. It can also interfere with the absorption of calcium, which is necessary for growing strong bones and teeth.
The longer a child is exposed to lead, the more it gets distributed to soft tissue and bones, says Dr. Baum, who is also a professor of pediatrics (emergency medicine) and of emergency medicine at Yale School of Medicine. “Then, there is this constant interplay where lead moves within blood, bone and tissue,” he adds.
What are the symptoms of lead poisoning?
Typically, patients with low levels of lead poisoning exhibit no symptoms, says Erin Nozetz, MD, a Yale Medicine pediatrician and associate director of the Pediatric Lead Program. Those with higher levels may experience such problems as behavior and learning problems, abdominal pains or anemia. But because each child may experience symptoms differently, it’s hard to know what to look for.
Whether a child’s problems are caused by lead poisoning or something else can be hard to tease out, she says, noting that both lead poisoning and autism can cause developmental delay, for instance. “It’s tricky because autism can become apparent between ages 1 and 2, which is when we first check for lead,” says Dr. Nozetz, who is also an assistant professor (general pediatrics) at Yale School of Medicine.
Adds Dr. Baum: “If developmental delay is a problem, we hope to immediately remove the child from the environment. But it can become a vicious cycle where parents may think, if their child is diagnosed with lead poisoning, that alone may be the reason for a developmental problem, which is not always the case.”
Who is at risk for lead poisoning?
Children between ages 1 and 3 who live in housing built before 1978 are especially at risk for lead poisoning. (Lead was banned from commercial paints in the United States in 1978, but many homes have not been remediated. Many toys and other products made outside the U.S. have been found to contain lead, too.)
“At 12 months, children have developed a fine pincer grasp, so they can pick up small objects and put them in their mouth,” says Dr. Baum. “And at that age, they can usually walk over to windowsills where there might be lead dust.”
Lead is especially a problem in Connecticut, where three-quarters of the housing stock was built before 1978, says Marta Wilczynski, a licensed clinical social worker at Yale’s Lead Poisoning and Regional Treatment Center.
“It’s not a problem exclusive to low-income housing. The rates of lead poisoning are higher in urban, multi-family units, but there are plenty of middle and upper class families living in historic homes,” Wilczynski says. “They’re attracted to the charm of beautiful stained glass, built-in hutches, and white picket fences—all of which often contain lead.”
Health department ordinances vary from town to town and most people are not aware of the implications of identifying lead hazards in or on their property, she adds.
If you suspect your home may have lead, ask your local health department for information about how to perform an evaluation or contact our Lead Poisoning and Regional Treatment Center.
How is lead poisoning diagnosed?
A child (between ages 1 and 5) may be diagnosed with lead poisoning if the levels of lead in their blood is 5 micrograms per deciliter or higher. In Connecticut, children are first tested for lead poisoning around age 1 and, again, at 2. A simple finger prick is administered to collect a blood sample.
Pediatricians generally do a great job of screening children at 12 months, but don’t do as well with the 24-month screening, Dr. Baum says. “That’s a problem because 2-year-olds are into everything. Our message is to make sure you screen children again at 24 months.”
Parents are urged to ask their pediatricians for this screening, if it is not offered, Dr. Baum says.
What happens if a child has lead poisoning?
There are two regional lead treatment centers in Connecticut: Connecticut Children’s Medical Center in Hartford covers the northern portion of the state, and Yale’s program covers the southern region.
If a pediatrician identifies lead poisoning in a child through a routine blood test, the child will be referred to the closest regional treatment center. If you live in another state, contact your local health department or your child’s pediatrician.
Depending on the situation, the child will either come in for an appointment, or we will schedule a home visit. “Because no two cases are the same, we try to customize care,” Wilczynski says.
How is lead poisoning treated?
The best treatment for lead poisoning is to remove the source of contamination—and to secure safe, lead-free housing for families. For children with low levels of lead, simply avoiding exposure can be enough to reduce it. “The two biggest things are to identify the source of the lead and to do a proper remediation,” Wilczynski says. “An iron- and calcium-rich diet helps because lead can compete with both of these in the body.”
For severe cases (45 micrograms per deciliter or greater), which are infrequent, doctors may recommend chelation therapy, given by oral or, rarely, intravenous and intramuscular routes.
What stands out about Yale Medicine’s approach to treating lead poisoning?
At Yale Medicine’s Pediatric Lead Program, we fuse medical, social work, and public health services to treat all lead poisoning cases, from the most benign to the most severe, and we offer the most up-to-date medical options. Our team is dedicated to spreading awareness and making lead poisoning a thing of the past.