Feds mull lower lead poisoning trigger for children

A panel of experts says the current lead poisoning level is set too high, and local prevention professionals are cheering a recommendation to lower the federal threshold for diagnosing children.

Right now the trigger point, sometimes called the “level of concern,” is 10 micrograms per deciliter. Advisers gathered by the Centers for Disease Control and Prevention want to drop the level to five.

“Not long ago it was 20, and when I was in medical school at Jefferson in the 70s, it was 60, then 40, those are all considered now to be frighteningly high levels,” said Curtis Cummings, a physician-researcher at the Drexel University School of Public Health.

Cummings says there’s strong evidence that children suffer health problems that can lead to lower IQ scores and behavior issues when their lead levels are below 10 micrograms.

In 2010, about 1,000 Philadelphia children under age 16 had blood lead levels over 10 micrograms per deciliter, according to the city Department of Health. A city epidemiologist estimates that about 4,000 more children in Philadelphia had a blood level between 5 and 9.9 micrograms per deciliter.

Pediatrician Carla Campbell says many doctors have agreed for years that the threshold level should be lowered.  But the question has been: How low?

“So we have yet to find a lead level where we say: ‘That’s safe.’ I like to say that no lead is good lead,” Campbell said.

Campbell says the CDC advisors are also reiterating steps governments can take to make housing safer.

She says Philadelphia is making strides.

In 2002, Philadelphia established a specialty court to speed the cleanup of lead hazards in apartments and rented homes. Last year, Campbell and colleagues released an analysis of the program.

Before the court, landlords cleaned up lead hazards and fixed problems within the first year about 7 percent of the time. After the court was in operation, that rate rose to about 77 percent.

This winter, the City Council passed an ordinance requiring landlords to take precautions before renting to families with small children.

“The property owner would need to bring in an inspector, take lead dust levels and those levels need to be under the EPA standards,” Campbell said. “So they have to certify that the property is lead safe before they bring in the next tenant.”

Philadelphia recommends blood lead level testing for all toddlers at age 1 and 2. Testing for high risk children should begin even sooner.

Doctors worry about very young children and older kids with developmental disabilities, who are more likely to put their fingers in their mouth, ingest paint dust that settles on floors, window sills and other surfaces.

In the last 20 years, lead poisoning rates in Philadelphia and across the nation have fallen dramatically with the adoption of rules to remove lead from gasoline and residential building materials.

Nearly 90 percent of homes in Philadelphia were built before 1978, the year when lead was banned from use in residential housing, according to Nan Feyler, the Philadelphia Department of Public Health chief of staff.

Whenever a child’s blood lead level tests at a “level of concern” someone from Philadelphia’s childhood lead prevention program inspects the home and orders the landowner to make fixes.

If the CDC adopts its advisory panel recommendation that could mean thousands more home visits and thousands more homes in need of repairs.

Philadelphia’s program receives grants from the CDC and the U.S. Department of Housing and Urban Development.

Feyler says Philadelphia’s HUD grant money for lead paint prevention has been cut nearly in half, and the federal budget proposal for similar CDC money is in jeopardy, too.

“The move to a lower threshold is the right move, still, there’s a real worry that demand will increase just as funding is going down,” Feyler said.

Taunya English’s story is part of a project on health care in the states a partnership between WHYY, NPR and Kaiser Health News.