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CDC advisers call for less allowable lead

CDC advisers call for less allowable lead

What constitutes an elevated blood lead level in children? A draft report issued by an advisory committee of the Centers for Disease Control and Prevention in January 2012 says the threshold of concern should be lower to protect children. The report, based on the latest science showing that adverse health effects in children can take place at a blood lead level (BLL) of 5 micrograms per deciliter of blood, argues that the current level of concern—10 micrograms per deciliter—is too high. This makes it more crucial to protect children from exposure to lead in the first place, according to the report.

If adopted, the number of 1- to 5-year-olds identified as having elevated BLLs would reach approximately 450,000 in the U.S., according to the report. This should trigger interventions that include environmental investigations, lead-related education, and additional medical monitoring. Consumer Reports has long believed that the CDC should lower its definition of lead poisoning to 5 mcg/dL. [Update: In May 2012, the CDC officially changed its recommendations, establishing 5 mcg/dL as the reference level to identify children whose blood lead levels are much higher than most children’s and who therefore require case management.  For more details on this change, see CDC’s “What Do Parents Need to Know to Protect Their Children?”]

Created at the request of the National Institute for Occupational Safety and Health (NIOSH), part of the CDC, the National Toxicology Program’s report was “an overview of the science to date, an evaluation of the evidence of health effects of lead in humans,” says Andrew Rooney, Ph.D., senior health scientist at the U.S. National Toxicology Program, who led the development of the document. “Lead exposure is a significant human health concern,”  Rooney says, adding that the report builds upon what other agencies—including the Environmental Protection Agency (EPA), the Agency for Toxic Substances and Disease Registry (ATSDR), and the CDC—have said for years. The conclusion: “Elimination of all lead exposure from the environment is our best course of action,” Rooney says.

Lead can be toxic to people of any age, but young children are at greatest risk because their bodies absorb more of it, and they are more vulnerable than adults to the effects of lead exposure. Hundreds of thousands of children in the U.S. have elevated levels in their blood, according to the National Center for Health Statistics. Even at the lower threshold of 5 mcg/dL, lead in the blood can have adverse health effects on a child’s cognitive function, academic performance, and endocrine systems—effects that may be irreversible. Too much lead in a child’s blood may lead to anemia, decreased muscle and bone growth, hearing damage, learning disabilities, nervous system and kidney damage, speech, language, and behavior problems, and brain damage. At extremely high levels (about 70 mcg/dL), it can cause severe neurological effects in children, and lead to lethargy, convulsions, coma, and even death. But even at extremely low levels, the World Health Organization reports, effects have been observed on the metabolism, kidneys, and cardiovascular symptoms.

The good news is that since the 1970s, the average blood lead levels in children younger than 6 has dropped by about 90 percent because of a federal ban on lead in house paint and gasoline. Still, in the U.S., lead-based paint hazards, including deteriorated paint and lead-contaminated dust and soil, remain the largest contributors to childhood lead exposure. And children between the ages of 1 and 5 have consistently higher BLLs than any other age group because they handle lead-contaminated dust, soil, paint, toys, and more.

A fetus can be exposed to lead in the womb, since it can cross the placenta, and as a result, infants are usually born with a lead blood level similar to that of the mother. This lead transfer can contribute to adverse effects in the fetus, including reduced growth and kidney damage. Currently, the CDC recommends follow-up blood lead testing and interventions for pregnant women whose blood lead levels are equal to or greater than 5 mcg/dL.

Since no amount of lead in the blood is safe, the report recommends that public health, environmental, and housing policies increase awareness of the hazards, prevent the exposure to children (vs. after-the fact intervention), and help children with high lead levels with nutritional intervention.

Consumer Reports has been continuously concerned about lead exposure among children starting with a report on lead in children’s toys (PDF) in the magazine’s first issue, in May 1936. The article stated, “Numerous small, one-piece metal toys such as soldiers, automobiles, airplanes, etc., were found to be made of a soft metal alloy containing a high percentage of lead.” Lead, we reported then, “is a poison which accumulates in the body, and can do great damage in amounts almost infinitesimally small” and that “some medical authorities believe that lead presents one of the gravest hazards of childhood.” As recently as January 2012, we reported on arsenic and lead in juice. “The science has been indicating for some time that there may be no safe limit of lead for children, who are more vulnerable to its toxicity,” says Urvashi Rangan, director of Consumer Safety and Sustainability for Consumer Reports. “A lower lead tolerance for children makes total sense.”

Here are common sources of lead and ways you can reduce or eliminate your child’s exposure to it.

Water
You can’t see, smell, or taste lead in water, and boiling will not get rid of it. Residents in homes built before 1975 may have lead in their water due to lead pipes, lead solder in the pipes, or lead deposits still in pipes. If you rely on water from a municipal utility rather than your own well, the pipes that bring water to your home are another possible source of lead.

Dangerous contaminants such as lead (as well as chloroform, arsenic, nitrate, nitrite, radon, and E. coli bacteria) can be common in tap water. (See our water filters buying guide and water filter Ratings for related information and models suitable for removing many such contaminants.) Bottled water, often advertised as a “natural” alternative to tap water, is generally safe but is actually less regulated by the Environmental Protection Agency than municipal water supplies. Indeed, some bottled water is simply filtered tap water.

If you decide to use a water filter, it’s important to know what contaminants are in your water so you can match the filter to the problem. If your water comes from a utility, you can find out what’s in it by checking your consumer confidence report (CCR). The EPA requires utilities to provide a CCR to their customers every year. You might find the CCR printed in your newspaper, posted on your local government website, or listed on the EPA’s website, where you can find local drinking water information by location. Consumer Reports’ most recent analysis of CCRs from the 13 largest U.S. cities showed that all had samples containing significant quantities of contaminants. A CCR might indicate safe levels of a contaminant when your water actually has experienced potentially harmful spikes. Also, a CCR tells you about the water in your municipality but not necessarily about what’s coming out of your particular tap. Only testing your home supply can do that. And of course, home testing is the only option if you have your own well.

If you think your water might contain lead, call the EPA’s Safe Drinking Water Hotline at (800) 426-4791 or your local health department or water supplier to find out about testing. Learn more in the EPA’s ground water and drinking water portal, and check the EPA’s listing of laboratories that test drinking water by state.

To reduce your family’s exposure to lead, the EPA advises that you use only cold water for drinking or cooking (never cook or mix infant formula using hot water from the tap) and run the water from any tap for about 15 to 30 seconds before use. If water has been sitting in your home’s plumbing for more than six hours, be sure to let it run until the temperature cools before cooking, drinking, or brushing your teeth.

Paint
Lead as an ingredient in house paint was outlawed in the United States in 1978, but if your home was built before then it probably contains some. Lead paint can gradually deteriorate into flakes, chips, and fine dust that’s easily inhaled or eaten by small children. The release of lead paint is often a problem when it’s disturbed during renovation or if it’s on surfaces that get lots of wear, such as windows, doors, stairs, railings, porches, and fences. To permanently remove lead hazards, you should hire a certified lead “abatement” contractor. Abatement or permanent elimination methods remove, seal, or enclose lead-based paint with special materials. Just painting over the hazard with lead-free paint isn’t enough. To find out if your home has any lead hazards, consider having either a risk assessment or a lead inspection done. Find out which one makes more sense for you in the EPA’s lead reference guide for parents.

In April 2010 federal law began requiring that contractors doing renovation, repair, and painting projects that disturb more than 6 square feet of paint in homes, child-care facilities, and schools built before 1978 be certified to follow specific work practices to prevent lead contamination. Check the EPA’s website to read more about the renovation requirements, find EPA-certified contractors in your area, and get more tips for families and child-care providers who are considering a renovation.

Lead test kits can be a good first step in identifying whether there’s a problem, since professional home inspections for lead paint can cost hundreds of dollars, Consumer Reports’ tests revealed. (See our lead test-kit Ratings and buying advice.) The kits we tested detected lead levels as low as 2,000 ppm in our home-based tests; in our lab tests, some detected lead at levels below 1,000 ppm. The Department of Housing and Urban Development considers paint lead levels starting at 5,000 parts per million (ppm) or 1 milligram per square centimeter (1 mg/cm2) high enough to require evaluation in federally funded or aided housing.

Lead test kits use one of two chemicals to detect lead by color change. Rhodizonate-based lead kits can yield false positives on red or pink paint; sulfide-based kits can yield false negatives or positives on dark paint. For more reliable results, use one of each type of kit. (If you’re color-blind, don’t use a kit that turns pink or red.) Follow instructions exactly and make sure that every layer of paint is exposed. Experts say that homeowners with a lead level of 4,500 ppm should consider remediation (5,000 ppm is the government’s action level for house paint). Our testers found that exposing the layers of old paint took strength, dexterity, and lots of practice.

If your home has lead paint underneath layers of lead-free paint in an area that gets wear, you notice flaking or chipping, or if your child tests positive for lead, find a certified lead inspector or risk assessor to detect and stabilize it. Your regional EPA office has data on certified professionals, or get more information on the EPA’s website or the national Lead Information Center’s website. You might be eligible for government-insured loans to help defray costs.

If your child spends more than 10 hours a week at a child-care provider in a building built before 1978, check the facility for lead hazards including:

  • Interior areas with cracking, chipping, or peeling paint.
  • Exterior areas with flaking paint, which can contaminate nearby soil where children play.
  • Nearby structures such as bridges or water towers with peeling or flaking paint that could contaminate the soil around play areas.

Also make sure that staff members wash any children’s items that fall on the floor or ground, and that they make the children wash their hands thoroughly after playing outside and before eating or sleeping. Make sure play areas are free of dust and cleaned regularly.

Soil and dust
Lead particles from gasoline additives or paint can settle on soil and stay there for years. Because of the amount of lead that was put into the atmosphere before it was banned from gasoline in the U.S., there are higher levels of lead found in soil near roadways. Lead can also be released into the environment through mining (and the mining of other metals) and from factories that make or use lead, lead alloys, or lead compounds. Before the 1950s it was also commonly found in pesticides applied to fruit orchards. Lead levels can be high in urban areas where older homes once stood, and once soil is contaminated, lead sticks to soil particles and remains in the top layer. It can also fall to the ground from the air and from painted buildings, bridges, and other structures. Landfills might contain waste from lead-ore mining, ammunition manufacturing, and other industrial activity, such as battery production and the disposal of products containing lead.

Lead-contaminated dust, soil, paint, and water are all associated with blood lead levels above the warning limit for children. Local public-health departments and county extension services often offer free soil testing or can recommend schools or companies that do it for a fee. There are also private companies that can do the job.

Other simple steps can reduce your exposure. Wash your hands and your children’s hands frequently, especially before eating and sleeping. Clean floors and other surfaces weekly with a wet mop or damp rag and an all-purpose cleaner to reduce transferring contaminated dust or soil. Keep children’s play areas, toys, and items for eating and drinking clean. Remove shoes before entering your home. Planting grass to cover soil that might have high lead levels can reduce the hazard. Gardening may also contribute to exposure if the produce is grown in soil that has high lead concentrations, so always wash vegetables before eating to remove surface deposits.

Toys
As Consumer Reports found in 2007 (see the New worries over lead report PDF), toys can be another source of lead exposure along with dishes and other household objects. And consumers shouldn’t let their guard down, as we suggested in a 2009 follow-up report, “Lead in Toys: Keep on the Lookout,” when a Consumer Reports investigation found that some products identified in the 2007 report as being high in lead were still available in a few stores and online. Lead can be found in toys and other products with screen-printed or painted surfaces, including paint on plastic, fabric, or metal. Keys, key chains, cheap beads and artificial pearls, and metal jewelry for children have also been found to contain lead.

The current federal limit for the amount of total lead allowed in most new products for children 12 and younger is 100ppm (parts per million), which went into effect in August 2011. This new standard was called for by the 2008 Consumer Product Safety Improvement Act.

But worrisome levels of lead can still be found in children’s products. In December 2011 nearly 140,000 children’s travel cases sold at Target and Target.com were recalled because the surface coating contained excessive levels of lead. And in January 2012 about 7,000 packs of Super Luchamania Action Figures were recalled due to excessive levels of lead in their paint.

The federation of state Public Interest Research Groups recommends that you avoid toy jewelry or any jewelry for children due to possibly high levels of cadmium or lead. And always keep such small items away from young children and babies.

To help determine whether any children’s product you own has been recalled due to a violation of the lead standard, simply type the word “lead” into the “Search/Recalls & Reports” section of the CPSC product safety site, at SaferProducts.gov, and search for the toy you are concerned about. (You can also sign up on the site to receive product warnings and recalls as they occur, or to report a dangerous toy.)

You can check the U.S. Public Interest Research Group toy-safety site (usable on mobile devices) for some products that have been recalled by the CPSC. The U.S. PIRG also has a toy safety tip sheet, and you can read its full 2011 report, “Trouble in Toyland.”

Juice
In our recent investigative report on arsenic and lead levels in juice, Consumer Reports found that one quarter of apple- and grape-juice samples had lead levels higher than the Food and Drug Administration’s bottled-water limit of 5ppb. No federal limit currently exists for lead in juice, though mounting scientific evidence suggests that chronic exposure to lead even at levels below 5ppb can result in serious health problems. (Note that organic juices may still contain arsenic and lead if they’re made from fruit grown in soil where lead arsenate was used as an insecticide, a use that is now banned. Download a PDF of our complete juice test results.)

Consumer Reports believes juice should at least meet the bottled-water standard for lead of 5 ppb, particularly since that level was achieved by 41 percent of the samples we tested. While the AAP cautions that children younger than 6 should drink no more than 6 ounces a day, about the size of a juice box, to help prevent obesity and tooth decay (infants younger than 6 months shouldn’t drink any), the possible presence of lead in juice is reason enough to consider limiting it in your child’s diet. If you must give your child juice, dilute it with distilled or purified water.

Other sources of lead in children:
Occupational exposure from parents.
If you work with lead you could bring it home on your hands or clothes. Shower or change clothes before coming home, if possible, and launder your work clothes separately from the rest of your family’s clothes.

Residential exposure. If your child lives near a lead mine, smelter, or battery-recycling plant (even if it has been closed), he or she may have been exposed to lead. If you renovate or remodel your home without lead hazard controls in place, or if you disturb lead paint and/or create lead dust, or spend time in such an environment, you’ll probably be exposed to lead.

What you eat on. If your child dines on or drinks from lead-glazed ceramic pottery, he or she could be exposed.

Alternative or complementary medicines, herbs, or therapies. Lead can be found in some traditional (folk) medicines used by certain cultures. Lead and other heavy metals are put into certain folk medicines on purpose because they are thought to be useful in treating some ailments. Sometimes lead accidentally gets into the folk medicine during grinding, coloring, or other methods of preparation. You can’t tell by looking at or tasting a medicine whether it contains lead. Lead poisoning from folk remedies can cause illness and even death. Examples include powders and tablets given for arthritis, infertility, an upset stomach, menstrual cramps, colic, and other illnesses. Greta and Azarcon (also known as alarcon, coral, luiga, maria luisa, or rueda) are traditional remedies taken for an upset stomach (empacho), constipation, diarrhea, and vomiting, and for teething babies. Greta and Azarcon are both fine orange powders that have a lead content as high as 90 percent. Ghasard, an Indian folk remedy, has also been found to contain lead. It is a brown powder used as a tonic. Ba-baw-san is a Chinese herbal remedy that contains lead. It is used to treat colic pain or to pacify young children.

Exposure in a developing country or immigrant community. If you live in an immigrant community or have a child adopted from a foreign country, you or your child may have previous and/or ongoing lead exposure from imported products such as folk or home remedies, medication, toys, cosmetics, food, candy, ceramic ware, and other items.

Here’s how you can work with your doctors to manage your child’s lead exposure or your own.

Start with a blood test. Children should be tested for blood lead levels even if they seem healthy, particularly if they’ve never been tested before or meet certain criteria, such as living in a home built before 1978.

Because blood levels can rise if you (or even your child’s day care or babysitter) start to renovate or other exposure increases unexpectedly (say, your child gets a new toy that contains lead), it’s important to have your pediatrician screen him or her. (See our report on Lead in the home and children’s toys in PDF.) Given the uncertainty of individual blood lead test results, it is important to confirm the results because levels can be affected by residual lead on the skin at the puncture site. If one of your children has a high blood lead level, consider having your other children tested since there’s a likelihood of similar exposure.

The CDC recommends initial and follow-up screening for pregnant and lactating women, as well as for newborns and infants of women with BLLs higher than or equal to 5 mcg/dL. If you are pregnant or lactating and have recently immigrated from or reside in areas where lead contamination is high, such as countries where leaded gasoline is still being used (or was recently phased out) or where industrial emissions are not well-controlled, you may also want to be screened for lead, since it can cross the placenta to the fetus.

Our experts say it’s important to ask your doctor for the actual level (and not just get an assurance that the level is “safe” or “unsafe,” for example) because he or she might not be up on the latest CDC recommendation of 5 mcg/dL rather than 10 mcg/dL as the reference level indicating the need for further action. “If a lead level is too high, then you have to try to figure out where it’s coming from and remediate, ASAP,” urges Jean Halloran, Consumer Reports’ Food and Product Safety Campaign Director.

Immigrant and internationally adopted children. The American Academy of Pediatrics suggests that pediatricians screen all immigrant, refugee, and internationally adopted children when they arrive in the U.S. due to their increased risk for lead exposure. According to the CDC, the risk is higher in many countries where children are adopted before moving to the U.S., and the agency also recommends that any adopted child get a blood lead test during a medical examination in the U.S. Children from some immigrant communities are at greater risk of having a higher BLL, and having it outside of the typical 1- to 5-year-old age range, according to the advisory board’s report, so it recommends that immigrant children of all ages—including international adoptees—be tested for lead exposure, with home evaluation to identify sources if needed.

Children with developmental delays. Developmentally delayed children who have hand-to-mouth behavior beyond the typical age range should also be candidates for continued monitoring.

Nutrition is a key weapon. Since certain vitamins and minerals, especially calcium, iron and vitamin C, play a role in minimizing lead absorption, discuss nutrition with your pediatrician. A healthy diet can help reduce lead absorption. But since excess iron can be toxic, talk about a healthy nutrition plan for your child before making any diet or supplement changes.

Get more information. If your child’s pediatrician (or your ob/gyn) is not familiar with treatment protocols for lead exposure, he or she should consult with a medical toxicologist and/or regional Pediatric Environmental Specialty Health Unit (PESHU), or a clinician experienced in treating children with elevated BLLs. Other sources of information for clinicians and consumers include the National Pesticide Information Center and CDC’s Lead Poisoning branch.

Consumer Reports has no relationship with any advertisers or sponsors on this website. Copyright © 2007-2013 Consumers Union of U.S.

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