Lead poisoning in childhood can have lifelong consequences. National Lead Poisoning Prevention Week is the perfect time to learn more about lead and the consequences of lead on your family’s health. Pennsylvania has one of the highest counts of elevated lead levels in children^¹. Because lead can accumulate over time and cause permanent damage, it is important to recognize the different sources of lead exposure. So, what is lead? And what can lead poisoning do?

Lead is a heavy metal and neurotoxin that can accumulate in the body. There is no known safe level of lead. High levels can result in permanent intellectual disability, behavioral effects, and neurological effects, including coma and death. According to the World Health Organization (WHO), 30% of the world’s idiopathic intellectual disability is caused by lead^³. In children, lead poisoning causes irreversible injury to both brain and nervous system development.

Children’s bodies absorb and accumulate lead quickly. Symptoms may develop with values as low as 3.5 micrograms per deciliter (µg/dL); this value is even lower than recommendation levels made in the past^². Lead testing is not mandatory, but it is recommended for all children to be screened before 12 months and again at 24 months. A simple blood test can identify levels of lead in the body. Early treatment may prevent severe, lifelong consequences of lead exposure.

Sources of Lead Exposure in Pennsylvania

Lead can be ingested through contaminated dust or soil, water from leaded pipes, or food from lead-glazed containers. It can also be inhaled during manufacturing processes that burn lead like the smelting of lead batteries, processing recycling, and stripping lead-based paint.

Older homes are more likely to contain lead-based paint than newer ones. Because there are many older homes in Pennsylvania, the consumption of lead-based paint chips or inhalation of dust is one of the leading causes of lead poisoning in children. Older homes might also possess outdated plumbing systems and lead-coated pipes which may contaminate water sources.

Although the use of lead in the repair or construction of pipes and other plumbing fixtures was banned in 1991, older plumbing might still contain high levels of lead. Older institutional buildings- such as those used by daycares and schools- might be particularly at risk. While schools are not mandated to test their water sources for lead, a 2018 amendment to the Public School Code encouraged schools to do so. Since then, nearly 800 sources were tested against Environmental Protection Agency (EPA) actionable levels of 15 parts per billion (ppb). Some sources, which have since been disconnected or put out of service, showed lead exposure levels as high as 1,350 ppb which is 90 times higher than actionable levels defined by the EPA^³.

Battery manufacturing and recycling plants employ and support many families throughout Pennsylvania. Employees must be regularly monitored through medical surveillance and blood testing to ensure the levels of lead in their blood are within allowable limits. The standard for industrial exposure and allowable levels is currently set at 40 µg/dL. This level could still be too high for many workers, including those with health conditions, non-occupational lead exposure, accumulated exposure, or those with abnormal absorption rates^⁴.

Other Sources of Lead Exposure

Products like toys, plastics, and jewelry can be a source of lead exposure. Although lead-based paint was banned in 1978, it is still used by many other countries. Because 55% of countries do not have lead-based paint control policies, this paint might still be used in manufacturing^⁵. Lead-based paint has been found on toys produced outside of the United States. Antique toys and collectibles, even those made in the U.S., might also contain lead-based paint.

Because the use of lead in plastics creates a more flexible and heat-resistant product, it has not been banned⁶. When plastic is exposed to sunlight, detergents, or other products that break down its chemical bonds, it can be a source of lead exposure.

Costume, toy, and vending machine jewelry has been found to contain high levels of lead. Because lead is not usually absorbed through the skin, the jewelry is safe to wear. However, children may be exposed to lead if the jewelry is chewed on or swallowed. At least two recent cases of lead poisoning related illness or death have been attributed to jewelry that was swallowed by children^⁶.

Certain food sources might contribute to lead exposure, particularly some types of candy, alternative medicines, and spices. An analysis of difference spices discovered the presence of lead in over 50% of samples. Some spices, like Georgian saffron, had detectable levels of lead in 100% of samples. Although food actionable levels of lead are set at 2 ppb, Georgian saffron had lead concentrations of up to 48,000 ppb. Other spices with a high concentration or occurrence of lead were curry, chili powder, masala, turmeric, and paprika⁷. Candies and herbal remedies made from spices with high concentrations of lead will have high concentrations as well.

Symptoms of Lead Poisoning

Now that you know the most common sources of lead exposure in Pennsylvania, you might be wondering about the symptoms.

Symptoms of lead poisoning in adults can include:

• muscle and joint pain
• headache
• memory or concentration difficulties
• mood disorders or personality changes
• reproductive issues including miscarriage

Symptoms of lead poisoning in children can include:

• learning difficulties
• developmental delay
• hearing loss
• vomiting, constipation, or abdominal pain
• lack of appetite or weight loss
• fatigue

Newborns exposed to lead might also be born prematurely, have a lower birth weight, and experience slowed growth⁸.

Testing and Treatment of Lead Poisoning

There are two primary testing methods to check for lead exposure. A capillary sample can be tested using a finger or heel prick. Because this type of sampling can easily become contaminated by lead residue on the skin, a second capillary sample is needed to confirm positive results.

A venous sample, or blood draw, provides the most accurate result because it is less likely than capillary sampling to be contaminated by lead on the skin. This type of sampling uses blood directly from the patient’s vein.

When elevated levels are detected, treatment can begin. Some treatment is simply preventative, which removes lead from the environment and prevents recurrent exposure. Replacing lead-coated pipes, resealing lead-based paint, or otherwise removing the sources of exposure can be enough to lessen elevated blood results, particularly in low levels. For adults and children with symptoms of lead poisoning or high blood lead values, the most common type of medical treatment is chelation therapy. In chelation therapy, medication is used to bind to lead particles which can then be excreted from the body in urine. For severe cases or patients who are unable to undergo conventional chelation therapy, EDTA chelation therapy is used. This type of chelation therapy uses a chemical called calcium disodium ethylenediaminetetraacetic acid (EDTA) to bind to lead and must be given as an injection⁸.

 

Get Tested for Lead Today

Discuss any concerns or symptoms of lead poisoning with your physician. Testing for lead is easy and affordable, and in most cases is covered by insurance, including Medicaid and Medicare. Medicaid requires and pays for lead testing for children at 12 months and again at 24 months. Pediatricians should order lead screening tests for all children. If your child’s pediatrician has not yet ordered lead screening for your child, discuss this test at your next appointment. Prevention of lead poisoning is easier and less expensive than treatment- it also saves lives. HNL Lab Medicine Patient Service Centers offer convenient and accessible options for completing your family’s lab work.

National Lead Poisoning Prevention Week raises awareness of the common risk factors and exposures of lead poisoning. Be aware of products that may contain lead and sources of exposure in and around the home. Know how to recognize the symptoms of lead poisoning. Catch lead poisoning early by visiting your physician and obtaining an easy, affordable lab test. While National Lead Poisoning Prevention Week is a great start, the recognition, prevention, and screening of lead poisoning lasts all year. Talk to your doctor today!

 

References

¹ Hauptman, M., Niles, J. K., Gudin, J., & Kaufman, H. W. (2021). Individual- and community-level factors associated with detectable and elevated blood lead levels in US children. JAMA Pediatrics, 175(12), 1252. https://doi.org/10.1001/jamapediatrics.2021.3518
² Center for Disease Control and Prevention. (2022, September 06). Blood lead reference value. U.S. Department of Health and Human Services. https://www.cdc.gov/nceh/lead/data/blood-lead-reference-value.htm
³ Pennsylvania Department of Education. (2022, August). Information for Schools: Lead in Drinking Water. Commonwealth of Pennsylvania. https://www.education.pa.gov/Schools/safeschools/resources/Pages/Lead-in-Drinking-Water.aspx
⁴ Occupational Health and Safety Administration. (2019, May 14). 1910.1025 App B - Employee standard summary. U.S. Department of Labor. https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1025AppB
⁵ World Health Organization. (2022, August 31). Lead poisoning. https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-health
⁶ Center for Disease Control and Prevention. (2022, February 01). Lead in consumer products. U.S. Department of Health and Human Services. https://www.cdc.gov/nceh/lead/prevention/sources/consumer-products.htm
⁷ Hore, P., Alex-Oni, K., Sedlar, S., & Nagin, D. (2019). A spoonful of lead: A 10-year look at spices as a potential source of lead exposure. Journal of Public Health Management and Practice, 25(1). https://doi.org/10.1097/phh.0000000000000876
⁸ Mayo Clinic. (2022, January 21). Lead poisoning. https://www.mayoclinic.org/diseases-conditions/lead-poisoning/diagnosis-treatment/drc-20354723