Only a fraction of hazards are caught, fixed
Lead paint hazards are prevalent in the Cleveland area. Poisoning of children in the first 2000 days of life - before they start kindergarten - can have devastating impacts.
(Gus Chan, The Plain Dealer)
CLEVELAND, Ohio -- If there were just a handful of things parents could do in the first 2,000 days of their child's life to put them on a successful path, preventing exposure to lead-based paint would be near the top.
The toxin is present in most homes built before lead additives were banned in 1978. It is also found in the soil, where it was deposited for decades by cars and trucks that formerly used leaded gasoline.
Curious little ones ingest lead, often as dust, as they scoot about on hands and knees or toddle to peer out windows.
Seemingly harmless habits of chewing on fingers or finding comfort in sucking a thumb, can transport the toxin into a child's developing body.
Eating chips or flakes of the paint ratchets up the immediate danger of convulsions or coma and the chance of lifelong affects.
Here's why: Decades of research shows that lead paint blunts critical brain development that, before age six, sets the stage for academic achievement and behavior.
A child's body has no useful purpose for the metal, so it travels around, lodging itself in growing bones and disrupting parts of the brain that manage things like impulse control and memory. The early-on interference by the insidious toxin can result in a host of hard-to-overcome problems.
In the Cleveland area, more than 10,000 children have tested for elevated levels of lead in their blood in the past five years.
The list of potential health and educational impacts for those children are devastating.
They can have lower intelligence quotients (IQs) that, research shows, leads to diminished earning potential.
They are less likely to be ready for kindergarten and able to meet third-grade reading standards, according to studies based on lead and educational testing of kids in county universal pre-kindergarten programs and Cleveland schools.
They can also suffer from a host of chronic health problems later in life, including kidney disease, high blood pressure and osteoporosis, according to numerous studies following lead poisoned children as they grow up.
"The evidence is very clear that lead poisoning affects children's educational outcomes with regard to reading and math scores," said David Jacobs, research director at the National Center for Healthy Homes and former top official at the U.S. Department of Housing and Urban Development.
All of that adds up to a high cost for families - and for the community.
National studies estimate that for every dollar spent to prevent the problem, between $17 and $221 could be saved.
"It's important to think about this in terms of everyone's child can be affected," Cuyahoga County Board of Health Director Terry Alan told group gathered to discuss efforts to tackle the problem this fall.
The good news, though, is that lead poisoning can be prevented.
The not-so-good news is that, while progress has been made in some areas, no city or state has entirely eliminated the problem.
Despite the fact that a wealth of evidence and technical know-how points to identification and remediation as the answer, public health efforts have focused heavily on reacting to children already poisoned.
That's been true locally, where city and county programs have focused on responding to homes where children are already poisoned to provide education and assist with efforts to remediate or abate lead.
However, efforts are underway to find ways to target dilapidated homes that have poisoned multiple children by potentially short-listing them for demolition.
Public health, government officials and area hospital systems have also been quietly studying and discussing creative ways to pay for local prevention and remediation efforts, which currently rely on mostly on federal grants and state reimbursements.
"The need to help children with high blood lead levels and remove the lead hazards in a timely, appropriate way remains critical," said Mary Jean Brown, who heads the Centers for Disease Control's Healthy Homes and Childhood Lead Poisoning Prevention program.
Nationally, the average blood lead level in children under 6 has dropped 10-fold since 1979, she said.
So has the disparity between the risk for poisoning for poor and minority children versus more affluent white children, said Brown, who got her start as a public health nurse in Cleveland.
"This victory is tempered by our not being able to find a safe blood lead threshold for young children and it reinforces primary prevention has to be our goal," she said.
That's also because research has shown that any level of lead in a child poses a danger. Lead-safe housing needs to be the standard, Brown said in an email.
"Like smoke-free, use of seat belts, and other such preventive interventions, this kind of societal change takes decades to achieve."
So what can parents and caregivers do in the meantime to make sure their child's environment is a safe as possible?
Be on the lookout for potential hazards.
If you live in a home or your child spends time in one built before 1978 that could contain lead paint, look for visual signs of deterioration.
Lead paint poses a risk when it releases particles that can be ingested. Chipping, peeling and flaking paint all are signs of a hazard. Harder-to spot dust can also accumulate near doors and windows that are being opened and closed.
Some parents may be tempted to rely on lead testing kits from home improvement stores, but the Consumer Product Safety Commission has found them to give false negatives and positives, said Stephanie McConoughey, a sanitarian specialist said.
If any signs of a hazard exist, a professional inspection should be done. The county does them as inexpensively as $250 and the Ohio Department of Health maintains a list of qualified lead risk assessors.
Ask landlords or home sellers for more information
Renters, under the law, have a right to know if there are potential or known lead hazards in a home or apartment before they sign a lease, said Angela Shuckahosee, of the Cleveland Tenants Organization.
This is sometimes a glossed-over part of signing a lease, in part, because of poor enforcement of law that require landlords to disclose hazards.
Renters can ask landlords whether their unit has ever been assessed for lead and what the results were.
If tests show a child in a rental home has an elevated level of lead in their blood, a landlord is required to address the problem.
Shuckahosee said her organization can walk a tenant through those rights - and what recourse can be taken if a landlord fails to act.
"We can discuss the exact dialogue to be had," she said. "There are definitely legal protections in place and renters should be aware they exist."
Home buyers considering whether to purchase properties built before 1978, know that lead hazards are not automatically included in home inspections often required by a bank.
But an assessment may be a worthy investment of between $300 and $600, depending on the size of the home and scope of the inspection.
Learn to live lead safe
Lead hazards can be dealt with by removing or remediating lead hazards.
Full abatement, or removal of lead, is normally suggested for areas like windows and doors that are repeatedly opened and closed and create friction that can release lead dust. This can mean removing all of the lead paint or replacing the windows or doors.
For other areas, baseboards, walls or other flat surfaces, lead can be encapsulated with paint.
Dust and flakes created by lead paint can be controlled inexpensively but it takes continuous effort.
"Every house is different," said McConoughey, the county sanitarian. She said common advice is for people to take off their shoes when they enter their home and wipe the paws of pets who run around outside. Lead can be tracked in from exposed dirt or if it is flaking off the outside of homes or garages.
McConoughey said using a vacuum with a special HEPA filter and wiping down hard surfaces with wet rags or paper towels helps to eliminate lead dust.
Since the metal isn't soluble, if not cleaned properly, it can be spread around. Cleaners with tri-sodium phosphate help bind to the lead dust and can be purchased at most hardware stores.
Know the risks of renovation
One source of lead poisoning occurs when dust is released into the environment during renovation, where lead safe practices aren't used.
Bruce Lanphear, who for decades has studied lead poisoning, said that's often how children in more affluent families are poisoned.
McConoughey said it's not recommended that homeowners or contractors who haven't taken the Environmental Protection Agency-approved lead safety classes try to remove hazards on their own.
"We don't want people scraping and painting if they don't know how to properly do it," she said. "It could create more of a problem."
If hiring a contractor, make sure they are EPA-certified to do renovation in homes with lead paint, she said.
Get children tested
Startlingly few children - only 1/3 or less -- who are at risk for lead poisoning in the Cleveland area are screened for the toxin. Most children under 6 in Cleveland and many inner-ring suburbs could be at risk if they live or spend time in older homes or buildings.
Testing is a vital way to catch the problem so lead in a child's blood can be reduced and the risk can be abated or eliminated for children who might live in a home in the future.
Parents should check with their family doctors about getting this blood test or go to a free testing clinic. Cleveland runs two clinics that offer testing.
The J. Glen Smith Health Center at 11100 St. Clair offers testing the first, second and fourth Wednesday of the month. The Thomas F. McCafferty Health Center at 4242 Lorain Avenue offers testing on Tuesdays.
What if your child does have a positive test for lead?
First thing is to prevent the child from ingesting more lead.
"Handwashing, handwashing handwashing. We can't say it enough," McConoughey said.
Use soap and water to wash your child's hands frequently, especially before they eat. Tip their hands downward so that dirt and lead particles rinse off the hands and down the drain. Don't use hand sanitizer; it won't remove lead dust.
Make sure your child is getting enough calcium and iron, which can help your child absorb less lead into their body.
Increase the amount of nutrient-rich meats and vegetables in the child's diet. Doctors often recommend an iron supplement and iron-rich foods such as dark green leafy vegetables, lean red meats or poultry, tuna, salmon, fish, raisins, dates, prunes, dried beans, peas, nuts or sunflower seeds.
Foods with calcium and Vitamin C can also help the body absorb less lead. Calcium-rich foods include milk, cheese, yogurt, green leafy vegetables, tofu, salmon and peanuts. Foods high in vitamin C include oranges, grapefruit, limes, lemons, strawberries, cantaloupe, kiwi, potatoes, sweet potatoes, tomatoes, broccoli, and bell peppers.
Though the affects of lead on a child's brain can't be reversed, it's even more important to stimulate children who have been poisoned, said says Dr. Jay Schneider, a pathology professor at Thomas Jefferson University in Philadelphia who studies the effects of lead poisoning on the brain.
In fact, doing so might help their brains find other ways to make up for the deficits caused by lead damage.
Dr. Dorr Dearborn said the Centers for Disease Control is now recommending stepped-up efforts to better educate lead poisoned children.
"We can raise them up," said Dearborn, Dr. Dorr Dearborn, professor emeritus at Case Western Reserve University and a lead poisoning expert.
Quality preschool programs can also offer needed enrichment and help track a child's progress and potential areas where they may need extra help.
Parents can do that with by reading, playing, writing, drawing, singing or dancing with their child.