Kids' Wellness Matters Podcast Ep. 6: Limiting Lead Exposure in Your Home

Exposure to lead at a young age can disrupt brain development, making lead intoxication a serious health concern. But lead lurks in many places and knowing where it may be hiding and how to protect children from exposure is important. Dr. Helen Binns, a pediatrician and director of the Lead Evaluation Program at Lurie Children's, specializes in caring for children exposed to lead and conducts significant research on the topic. Dr. Binns unpacks the myriad ways children might come into contact with lead, potential health risks, and strategies for contact prevention.

“When you have exposure to lead, it blocks some needed pathways in [brain] development. And young children in particular are rapidly changing in their brain development – the brain is just going from a small chute to a complex tree very quickly. You really need good pathways to establish your pattern for life. So, that's why we're particularly concerned about lead and children.”

-Dr. Helen Binns

Show Notes

• While any level of lead can impact health, recent national surveys indicate that 2.5% of U.S. children ages one to five have a blood lead level of 3.5 or higher. But Binns emphasizes that there's no safe level. 
• Even though laws resulted in a dramatic reduction of the content of lead in paint starting in 1978, a primary source of lead exposure today is deteriorating lead-based paint, especially in older homes. Children become exposed by ingesting leaded dust through hand-to-mouth contact. The presence of lead in drinking water, while not the most significant source, can also pose a danger. Other potential risks include contamination from imported products, older U.S. dishware, alternative medications, herbal remedies, lotions, jewelry, old furniture and home decor items.
• It is essential to remain updated with lead recalls via the U.S. Consumer Product Safety Commission and the Food and Drug Administration. 
• When you have deteriorating lead paint, it creates a lead dust hazard in the home. At-home test kits are available to test lead content in paint, and they are generally fairly accurate. However, they only test the surface layer of the paint, leaving underlying layers a potential health risk.
• Thankfully, acute symptoms like lethargy, vomiting, and seizures from lead poisoning are rare today. However, this emphasizes the need for regular screening, as many affected children remain asymptomatic.
• Ensuring excellent nutritional status in children is essential, especially in the context of potential lead exposure. For example, if a child is low in iron, gut enzymes will very efficiently absorb any other metals coming through, including lead. 
• Medications exist to treat extremely high lead levels, but they mainly prevent death and don't necessarily reverse long-term damage from lead. It takes a year for lead levels to drop by 50% once exposure stops.

Transcript

[00:00:00] Nina Alfieri, MD: Welcome to Kids Wellness Matters. I'm Dr. Nina Alfieri.

[00:00:07] Rob Sanchez, MD: And I'm Dr. Rob Sanchez. We are both parents and pediatricians at the world renowned Ann and Robert H. Lurie Children's Hospital of Chicago.

[00:00:15] Nina Alfieri, MD: On this show, we'll chat with a wide range of experts about caring for children from newborn to young adult. Because Kids Wellness Matters. Today's topic is a big one and a really important one, and so we are absolutely thrilled to have Dr. Helen Binns join us today to talk about lead. I don't know if you guys know this, but lead is basically everywhere.

[00:00:42] Rob Sanchez, MD: It kind of baffled me, but it really is everywhere. You know? Um, you have to think about homes, you have to think about shoes in the household.

[00:00:49] Nina Alfieri, MD: And I understand why, because you can track lead everywhere through the soil. It turns out that lead is something that's kind of ubiquitous in our environment and it's really important for all of us to know where lead is hiding and how it gets absorbed into the body.

[00:01:03] Rob Sanchez, MD: There is a lot of really strong research that shows that the first couple years of a child's development are so important for their brain development and for their long-term trajectory. And one of the things that can negatively affect development in babies is lead intoxication.

Those early childhood months, years are so key to that development. I see it in my own kid at home, they're expanding their brains. They're expanding, they're learning, they're taking on so much, and so you really wanna prioritize it.

[00:01:32] Nina Alfieri, MD: And many parents may recognize the discussion about lead because it is recommended by the American Academy of Pediatrics, to make sure that we're screening kids for lead In our clinic, we do it at one, two, and three, it's so important to catch when there's a high lead level, but it's even more important for us to understand where it is and how to avoid it.

[00:01:50] Rob Sanchez, MD: And when we do have abnormal results, that's where we really have to help advocate for our patients, reach out and help them find the resources that are there to make sure that this is an issue that that gets followed up on and helps get addressed.

[00:02:01] Nina Alfieri, MD: And Rob, we admitted not too long ago that we are gigantic nerds and we like medical history and the topic of lead is one that has a ton of medical history behind it, even from the times in ancient Egypt where people use coal eyeliner that had lead in it. And that was a source of intoxication. Present day there's lead that gets leached out of certain ceramics that is often a source. There's lead in certain spices, there was a big public health movement to decrease, and remove lead from paints and from gasoline. So this has been a huge public health story throughout the years.

[00:02:36] Rob Sanchez, MD: Over history change has happened in this area because folks spoke up, folks did the work and recognized that this was an issue. And as they spread that, as that knowledge grew, these decisions were made, these important policies, decisions, that have big impacts on wide swaths of the population. And it starts with that understanding and it starts with that awareness. And we're hoping we can contribute a little bit to that today. -

[00:03:10] Nina Alfieri, MD: For this episode, we want listeners to walk away with a better understanding of the risks and treatment of lead, and we really wanna talk about some things that you can start doing today to prevent exposure to lead in your children and in your families. So we're very lucky because our very own Dr. Helen Binns is an expert on this topic. She's a pediatrician and she's a director of the Lead Evaluation Program here at Lurie Children's. Dr. Binns cares for children exposed to lead and conducts research on this topic. And we're so excited that you're here with us today. Thanks for joining us.

[00:03:42] Helen Binns, MD: Well, you're most welcome.

[00:03:48] Nina Alfieri, MD:  Tell us a little bit about just the basics of lead and why does lead exposure matter for children? What kinds of things can it affect and why is it such a big topic for pediatricians and parents to look out for?

[00:03:55] Helen Binns, MD: Well, lead is a metal and it is a soft metal, and it has been commonly used in quite a number of manufacturing, gasoline things over the last, millennia, really almost, you know, since the Roman era, and lead can interfere with how the brain is developing. So when you have exposure to lead, it blocks some really needed pathways on development. And young children in particular are rapidly changing their brain development. So the brain is just going from a small shoot to a complex tree very quickly, and you really need good pathways to establish your pattern for life. So that's why we're particularly concerned about lead and children, And we know the research is out there now to really identify the levels that are quite low and they still can impact health. Our most recent data that we have from our national surveys, show that 2.5% of US children ages one to five have a blood lead level of 3.5 or higher. The CDC recommends a use of 3.5. and they still can impact health and there's no safe level. So we're trying to continue to work to really lower childhood and really personhood exposure to lead. So everyone.

[00:05:32] Nina Alfieri, MD: That's really helpful to know that there's really no safe level of lead and knowing that it's widespread in our environment. How common is it that lead poisoning happens today? Like how many kids are impacted and how has lead use and lead poisoning changed over time?

[00:05:48] Helen Binns, MD: I wanna start with a celebration that lowering of lead levels in US children is one of our really public health success stories. Back in the late 1970s. and this was a time period of which when the US Nation was exposed to breathing and lead in gasoline, 99.7% of US children, ages one to five had a blood level five or higher.

[00:06:15] Nina Alfieri, MD: Wow.

[00:06:16] Helen Binns, MD: So very high and 88% had a level 10 or higher because the average level was 14.9.

[00:06:24] Nina Alfieri, MD: Wow.

[00:06:25] Helen Binns, MD: Yeah. That's a wow. For sure.

[00:06:27] Nina Alfieri, MD: Thinking of all the kids we screen, that would be alarming for today's pediatricians. We're nowhere near that now.

[00:06:34] Helen Binns, MD: Correct. Yay success. So taking lead out of gasoline was a major success story and really dropped our frequency of having elevated lead levels very fast across the US population.

[00:06:47] Nina Alfieri, MD: I'm glad that we have quite a bit to celebrate. Looking ahead and thinking about the levels that we're still seeing, knowing that we've eliminated lead from sources like gasoline, where are the common sources of lead exposure today?

[00:07:42] Helen Binns, MD: Well, what we're seeing is really the lead we've put in the environment. And a major source of lead in our environment was lead in paint. And even though the guidelines and the national laws changed so that there was dramatic reduction of the content of lead in paint starting in 1978, there's a lot of deteriorated lead in paint that has contributed to the lead in dust. And the main pathway for children is floor to hand to mouth. So, you know, children do put their hands in their mouth frequently, objects in their mouth frequently. So really the most common pathway is still those sources that were in homes placed there in prior decades. There was a survey that found that if you live in a home built before 1940, you have a 67% likelihood of having deteriorating lead-based paint in your house. Wow, that's pretty high! If you live in a home built '40 to '59, you have a 39% chance and it drops if you're in a home 1960 to '77, it's an 11% chance. So still, lead in paint has contributed to a wide variety of lead in dust in your household. If you touch your hands on a windowsill that has lead based paint, you're gonna get dust on your hands. That can be a real problem. And it can contaminate the soil outside your home from your windows or your siding that has been painted over the decades. You know, paint and dust those are common things and we are gonna have this around here for a long time. A second identified source is water. In my experience, water is not a common high source of lead. Everybody drinks water. So even if you have a small amount of lead in your water, it's going to everybody. Right? So there is some exposure of lead in water. And we know that has been problematic. If you can think about the history of the high lead in water in Flint when they changed their water chemical systems and had a lot of corrosion and very high lead levels.

[00:09:28] Nina Alfieri, MD: Yeah, absolutely. And I think that was really helpful to hear about the main sources we should look out for in, especially in older homes with paint and the dust from paint and from the water mains into houses. What advice do you have for parents who are worried about lead in toys, and ceramics, and spices, and some of the other stories that we might hear?

[00:09:49] Helen Binns, MD: There are just some weird stories out there from families I've seen that have exposures of very unusual sources, and it is very hard to identify .The different categories. One is you may examine the Consumer Product Safety Commission Lead recalls. So you can go online for the US Consumer Product Safety Commission and get some of that. You can go online for the US Food and Drug Administration and look for lead recalls in supplements and in imported spices. In general, the things I usually ask about that are one off topics, not so much the dust or the water. Do you have any imported spices in your house? So you have to be careful what you've picked up from other countries where regulations may not be as tight as they are here in the US. You have to be careful with your dishware. So some of the older US dishware, like the older fiestaware actually had lead in the glazes. The older pewter has led in the pewter. Some of the dishes currently even being made in Mexico and China actually have lead in their surfaces on their decorations in those surfaces. So you have to be a little careful. I have had a child in the past who was an infant who, they were heating the baby food on a salsa dish that they got in Mexico and the child's lead level rose from the lead coming out of the lead in the paint content on that dish. I ask about alternative medications and herbal remedies even lotions or coal, surma, I ask about jewelry. I have had young children who chew or suck on jewelry that they may have gotten that actually has a lead content.

[00:11:52] Nina Alfieri, MD: That's really helpful and honestly good for me to know as I get some heirlooms from my grandma.

[00:11:57] Helen Binns, MD: I have had even a child who was in a new home and they put up old picture frames as part of the design, which poisoned the child. Or they've brought in an heirloom of a stained glass table, which poisons the child. They could just touch them, there's lead in dust, right? When you have deteriorating lead paint, it creates a lead dust hazard, and if you're just touching the dust, you get it on your hands, which you then put in your mouth. Old furniture can be a marked hazard. I've had people poisoned because they had the distressed chairs So the kid is learning to stand by touching the chairs. There is some kits you can get to test for lead content in paint. It's a little tube about the size of your little finger, which you crush in the middle, and it has a fluid at the end which you rub on the paint, and if it turns pink, then it's lead. You can use those kits and I tell parents to get a Q-tip and touch the fluid and you rub it on the paint and then get another Q-tip and touch the fluid and rub it on a different surface so they get a little more bang for their buck. But you can do some evaluation in that manner. The kits are fairly accurate. They only test for the surface layer of paint. So if your paint is underneath, the lead is underneath that is coming through, you may miss it. But at least it's a step in the right direction.

[00:13:26] Nina Alfieri, MD: Tell me a little bit about what the symptoms of lead poisoning are.

[00:13:29] Helen Binns, MD: We are so fortunate today in that most children who have levels of which we're concerned about are asymptomatic. There's no outward behaviors. In the seventies, there were deaths from children due to lead poisoning here in Chicago on a regular basis. We occasionally hear about a child now who has lethargy, vomiting, and may have a seizure. Those are happening at very high lead levels. These are children who have a very high source of lead exposure and their parents may not even realize it's happening. So again, you know, these acute symptoms are found in a few. But mostly there's not acute symptoms, which is why we do preventative testing and screening, and we don't wait for your child to have a seizure. We actually are really trying to address this on a regular routine basis so we can catch it while it's maybe low, and really help you to understand where it is and prevent further lead exposure.

[00:14:36] Nina Alfieri, MD: What a great testament to a successful public health strategy that the children that we're picking up now are asymptomatic. It's incredible. What can we do to prevent this from happening to our families? And as you're walking through your home, how can you identify and address lead hazards in your environment?

[00:14:54] Helen Binns, MD: Well, one is for sure, I would try and understand how old is your home. So you sort of have an estimate of risk and many renters don't know how old their home is. And so in that case, you sort of assume the worst, right? And act based on the worst. If you have areas of deteriorating paint, for sure, you need to really, try to keep your child away from those areas until you really know what they are. The other thing to really do is to ensure that your child's nutritional status is really sound. Nutrition is so important to child health and development. And one thing we know is that iron is an important nutrient for brain development, but it also sort of looks like lead. So if you have lead in iron coming through the body doesn't really know which one to grab, and if you're low in iron, your gut enzymes elevate and grab hold more efficiently of any of those metals coming through. So, if you're low in iron status, you're a very efficient absorber of any of that lead that's being ingested. So we really need to ensure really excellent nutritional status you know, fortunately, assessing iron status is an important part of a pediatric health visit. And our Lurie Children's doctors are doing that too, along with their lead screening.

[00:16:27] Nina Alfieri, MD: That's right. This is a part of our checkups at one, two, and three. But what are the national recommendations on lead testing and lead screening? This is another thing that I think could give parents some comfort knowing that this is routinely being checked in their kids. Tell us a little bit about those recommendations.

[00:16:45] Helen Binns, MD: Well, there are national recommendations and state specific recommendations and city specific recommendations. So there's a whole number of them. For children who are on Medicaid, there is nationally, there is mandated testing at ages one and two. And then, additionally at older ages if you don't have prior lead tests done. Chicago is considered all high risk, and Chicago adds testing at age three. Because the soil levels here in Chicago have been found to be quite high. And during that two year age period, we think there's more outdoor exposure and we are finding that some children had a low level at earlier ages are now turning high at age three. So, we sort of go above and beyond here in Chicago to get one, two, and three.

[00:17:36] Nina Alfieri, MD: So we've screened a child and what happens when a level is elevated? What are the next steps? What kind of treatments are out there and what can parents do at that point to minimize the impact of the exposure?

[00:17:49] Helen Binns, MD: Well, for every blood lead test done in Illinois, it's mandated that the result is reported to the state Public Health Department, who then forward that information to the appropriate regional County Health Department, as necessary. Then these families will get a reach out from the uh, health department nurse, , from the health department inspector to help them identify sources of lead in that child's environment and help them understand how to remediate or remove those sources of lead. And the inspection report is very important and understanding how to lower risk is very important because if you know you have lead. You have to really be very careful and know how to safely put the barrier between your child and that source of lead. I have seen children who are poisoned because a lead hazard was identified and then unsafe sanding and scraping occurred and the whole household became poisoned , from lead exposure. So you have to be very careful. The health inspection team can help you understand where your lead is and what are the strategies to really mitigate that sort of lead exposure. And the nurse is going to ask you a million questions just like I do when I see these patients to try and understand have we really identified the source and all the sources. Because we want to help you lower exposure through every source your child may be having to lead. And there are monies from the uh, US Housing and Urban Development, that are going for lead abatement at different county health departments. So there is funding out there. Because, you know, our goal is to help these children and we have to have the houses fixed to do that.

[00:19:48] Nina Alfieri, MD:  Dr. Binns, can you walk me through a little bit of some of the medical therapies that we can offer if a lead level is very elevated and we're concerned?

[00:19:56] Helen Binns, MD: So there are a couple medications we have used, to help lead levels fall a bit more promptly. In general, the medications we use prevent death. We would hope that medications reverse the damage from lead. But to date, the studies have not borne that out. The medications we use really are helping lower and prevent some of the more acute symptoms, but not the long-term outcomes. So the recommendations on use of these medications is to really only use them at levels that are quite high. So levels of 45 or higher do we give these medications. We give them for short term, you know, three to four weeks or so. And the medications act on the lead in your blood and help you pee it out more quickly. But in a child, only 5% of the body burden of lead is in your blood. Most is in the soft tissue and the bone, 70% is in the bone. So while you're on the medicine, your leads come down, but then you have established a new equilibrium and the lead comes out of your bone and your soft tissues to replenish the blood. So we do use that on occasion. Some children, it is an important means of therapy and allows us to get them out of the hospital and to move forward. But once you have lead in your body, it just takes a long time. If you can stop exposure to lead, and you reach a new equilibrium, it takes one year for your lead level to drop by 50%. So our medications aren't very good, so we are really trying, to focus on prevention to really understand your risks in your environment and, , make sure you get this preventative screening so you can identify where you may have lead and address it promptly

[00:22:02] Nina Alfieri, MD: I wanna thank you so much for all the work that you've done in your career for our families. I know when I moved into my new house, which is very old, that you were the first person I talked to for advice on where to look for the little, the little lead bugaboos all over my house. So, this is really such an important topic and I just wanna thank you from the bottom of my heart for everything you've done.

[00:22:22] Helen Binns, MD: Well, you're most welcome and you know, the families out there are working very hard to really create safe environments for their children, and it's very exciting to work with them.

[00:22:35] Rob Sanchez, MD: Thanks for listening to Kids’ Wellness Matters.

[00:22:37] Nina Alfieri, MD: For more information on this episode and all things kids’ wellness, please visit LurieChildrens.org