When Susan Thornfeldt and husband Greg Dasch moved into their clapboard colonial house, in an old section of Portland, Maine, it was, like most of its neighbors, pretty but run-down. The kitchen of the 180-year-old house was outdated, the wiring ancient, the paint peeling inside and out—but Susan and Greg loved the beautiful woodwork and historical details. They felt sure they could take on a renovation; Greg, a contractor, could do the work himself.
Since Susan was pregnant with their first child, the couple immediately tackled what would be the baby’s room, ripping out walls and repairing old windows. They wanted everything to be perfect. Their son, Sam, was born in September 1995, and Susan and Greg looked forward to raising a family in their dream house.
Two years later that dream house became a nightmare. “September 25, 1997: The date is etched in my mind,” says Susan. On that day she got a call from a nurse at Portland’s health department who explained that according to a recent test, the level of lead in Sam’s blood was 21 micrograms per deciliter. That figure meant that Sam’s blood contained twice the amount the Centers for Disease Control and Prevention considers harmful, and that under Maine law he was lead poisoned.
Susan was told that the state would step in; an inspector would be at her home shortly. The nurse added that so as not to further endanger Sam and his new sister, Alexandra, then 6 months old, Susan had to get herself and the kids out of the house—immediately. Susan called Greg at work, sobbing. I said, ‘This is so serious. I’m packing now, and we’re leaving.’”
“Lead poisoning.” If you don’t live in a big city, chances are you tune out when you hear those words. Many of us assume that lead poisoning is a problem of the past or of the urban poor. The truth is that lead still poses a lurking danger for kids across the country, in cities and suburbs alike; in fact, it’s the number one environmental threat to children. One million American children 6 years old and younger are poisoned today because old lead paint is hiding in 38 million homes (40 percent of the country’s housing) as well as in water pipes, in soil, and in schools and public buildings. These lead-poisoned kids are at risk for learning disabilities and other cognitive deficits; behavior problems, such as hyperactivity and aggression; and a host of other mental, behavior and physical problems.
Here’s the really bad news: New research shows that lead can be harmful in amounts far below what is considered dangerous by health officials. Right now the Centers for Disease Control and Prevention judges a blood-lead level of ten micrograms per deciliter to be excessive. But a study published by Bruce Lanphear, M.D., M.P.H., a professor of pediatrics at Children’s Hospital Medical Center in Cincinnati, found that children aged 6 to 16 with readings of 5 ug/dl and below—well below the point at which the CDC becomes concerned—had deficits in reading and math skills, short-term memory, and nonverbal reasoning skills.
The evidence that small quantities of lead are harmful is so compelling that the federal government is reviewing research to determine whether the CDC should revise downward the blood-lead level at which children are considered poisoned. But whether or not the standard is changed, the CDC, doctors, researchers, and other lead experts all agree: No amount of lead is truly safe.
In 1978 lead was banned as an ingredient in paint used on and in residences, but many homes built before 1978 still contain this hazard. Peeling and chipping paint isn’t the only problem: Lead dust is generated when painted surfaces rub together (such as when windows and doors open and shut) and during renovations, when paint is scraped and sanded; this dust collects on household surfaces and in soil and gets into children’s bodies when they put their hands or toys in their mouths.
While lead is also dangerous for adults, children’s developing brains and bodies are much more sensitive to its effects. Very little lead is needed to poison a child: The equivalent of a few grams of sugar a day over the course of a month can raise blood-lead content to dangerous levels and may cause permanent brain damage. Babies in utero are at risk too: Research shows that children born to women with elevated lead levels may have the same developmental problems as children who are later exposed to lead from paint and other sources.
What’s even more frightening is that unless children are tested at an early age, lead poisoning may only be detected after they’ve been poisoned for years and significant damage is already done. Children react to lead in different ways, and many lead-poisoned don’t show symptoms until they reach school age. And lead-poisoned children who do well in kindergarten and first grade often start to have behavior and cognitive problems and serious trouble with academics, particularly math, when they reach 7 or 8. Unless a child is diagnosed at a young age, there’s no way to know whether later problems are related to lead.
Susan and Greg had heard of lead poisoning, but never thought it had anything to do with them. For one thing, they had no idea that all the painstaking work they did to get their new home ready, such as scraping and sanding old paint—much of the work done while Susan was pregnant—could poison their child. In his contracting work, some of it on old houses, Greg had never heard lead discussed, either by other contractors or by homeowners. (Since 1999, the Environmental Protection Agency has required contractors to give homeowners its brochure on lead before beginning any renovations, but contractors are not required to be trained or certified in lead-safe work practices, says Carol Kawecki, program manager at the National Center for Healthy Housing in Columbia, Maryland.)
But when Sam was about 6 months old, Susan came across a passage on lead in a parenting book. The book asked three question to help parents assess their risk: Do you live in a house built before 1978? Are you doing or planning renovations? Does your child have a sibling, playmate, or neighbor who’s been diagnosed with lead poisoning? Susan answered yes to two out of three questions.
Not enough testing
Alarmed, Susan asked her pediatrician to screen Sam for lead, but the doctor balked. “She said, ‘Why do you want to put him through that? It’s invasive, and you don’t fit the profile,’” says Susan, rolling her eyes. Susan now knows that lead screening involves nothing more than a finger-prick blood test and that 60 percent of Maine’s lead-poisoning cases result from dust becoming airborne during renovations—which she’d told the doctor were taking place in her own home.
Hers was not the only under-informed doctor. The Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend that pediatricians provide information on lead poisoning to all parents of infants and toddlers and that they ask the parents a few specific questions to determine whether a child is at risk, but it’s left to the discretion of each doctor to do so. Fewer than a third of all states have mandatory lead testing for all children. In states that don’t have universal screening, pediatricians usually screen only children considered at high risk (children from disadvantaged families and those living in areas with lots of older housing or in areas where other children have been poisoned by lead.)
“I would suggest that every parent demand that their pediatrician test their child at 1 and 2 years of age,” says John Rosen, M.D., professor of pediatrics at Children’s Hospital at Montefiore Medical Center in New York; as head of the hospital’s lead program, he has treated more than 23,000 children with lead poisoning. Rosen also feels that all pregnant women should be tested at least once during their pregnancies, and preferably each trimester. “It’s better to be safe than sorry,” he says.
Watching and waiting
Frustrated by her pediatrician’s resistance, Susan switched doctors and finally got Sam tested. Sam’s first result, at 9 months, was 12 ug/dl, already over the danger mark. (Alexandra later hit 12 too, but never went higher.) The new doctor didn’t know much more about lead than the previous one knew, but she was willing to learn.
The truth is, there isn’t much doctors can do for a lead-poisoned child. Children with life-threatening levels of 45 ug/dL and above are treated with chelation therapy, in which a lead-binding drug is administered orally for 19 days or intravenously in a hospital for five days, to quickly decrease the amount of lead in the blood. Chelation doesn’t appear to reverse cognitive damage in kids with levels lower than 45 ug/dL, however. So for those kids the focus is on minimizing further exposure to lead. (Reducing exposure to lead hazards helps prevent further damage, but the lead already present in a child’s body remains there indefinitely; most of it is eventually absorbed from the blood into the child’s bones.)
Cleaning can reduce children’s exposure to lead dust—including mopping and sponging floors, window frames, windowsills, and other surfaces weekly; washing children’s hands often; and keeping play areas and toys clean. (See “What to Do if There’s Lead. . .,” below, for information about what to do if you find lead in your home.) Proper nutrition also helps, because calcium and iron slow the absorption of lead by the body.
But the most important step is to remove the source of the lead. “The child should be in a lead-free environment,” say Rosen. “Until the home is repaired, children should not be living there, if at all possible.” Unfortunately, no one told Susan and Greg this. Sam’s test results went to their state’s health lab, which conducts a lead-poisoning-prevention program, and the city sent Susan brochures explaining how to minimize children’s exposure to lead, with an emphasis on nutrition and cleaning. But no one told Susan to get Sam out of the house or that Susan and Greg should consider lead abatement—a removal of all lead from the home. Since the health department and Sam’s own doctor weren’t alarmed about Sam’s results, Susan assumed that cleaning would solve the difficulty.
Sam was retested every few months, and his blood-lead level kept creeping up. “With each result, I felt that it was because I wasn’t cleaning enough,” says Susan. “So I cleaned more.” In fact, she may have inadvertently created more lead dust, by vacuuming (which stirs up dust) and by opening windows (which causes the window frames to rub together) to let in fresh air. Susan remembers, “I kept hoping that if I just did it better, things would go away.”
Sam started showing emotional and physical symptoms Susan now thinks were due to the lead. At night he cried and cried, and nothing Susan did could soothe him. He often had headaches, and sometimes he had stomachaches so intense that Susan could relieve the pain only by pushing his knees into his tummy and hugging him tightly.
It was a stressful year. Susan was pregnant and then caring for a newborn, and she was cleaning the house daily. “We did the best we knew how to do, but we still feel a lot of guilt,” she says. “Looking back it’s heartbreaking knowing that he home you provided for your child was slowly poisoning him every day. There is no deeper feeling of sadness, frustration, and helplessness.”
After that fateful phone call in September 1997, Greg tried to calm Susan down. “I told her to get everyone out of the house. ‘I’ll take care of it. We’ll fix it.’” But neither of them knew whether it could be fixed. With that much lead in his system, Sam was at risk for permanent neurological damage.
Susan and Greg hired their own lead inspector, and Susan and the children stayed with various friends and relatives for three months while Greg learned about lead-safe work practices and gutted and rebuilt the house, replacing every single painted surface. All told, the abatement cost the couple $40,000.
When he was 3, Sam was given a full set of development diagnostic tests. He was nearly a year behind in gross motor skills and was found to have a sensory-integration disorder, a neurological condition that may or may not have been related to his lead poisoning. Sam can also be highly impulsive and aggressive, behaviors often linked to lead poisoning. In one incident at his grandmother’s house when he was 4, he grabbed a frying pan full of hot grease and nearly flung it on himself, stabbed an orange with a knife, and then, after being reprimanded, banged his head into the wall, all within a few minutes.
The good news is that so far Sam shows no signs of learning disabilities; he flew through kindergarten and started first grade this fall. But Susan is painfully aware that other problems may reveal themselves in the future. “I can’t say, ‘It’s OK, it’s over.’ We’re watching for new issues all the time.”
Susan has seen what can happen; she’s talked to other mothers, such as Kristin Joyner, 53, of Aventon, North Carolina, whose son Michael has severe lead-related neurological damage. When he was 1, his blood-lead level was fine, but when he was 15 months old, the Joyners moved from Virginia to an oldhouse in North Carolina. As part of a routine checkup with a new pediatrician, Michael’s lead was tested again, and came back at 22 ug/dL—just six weeks after the family had moved—peaking at 43 ug/dL two weeks later.
Until then Michael had hit all the normal developmental milestones, but within a month he began to lose skills. “He stopped eating and sleeping, and had tantrums for no reason,” says Kristin. “He was like a totally different child.” Regressing and failing to hit developmental milestones, as Michael began to do, can be early signs of lead poisoning in very young children, says pediatrics professor Rosen.
By 5, Michael was no longer able to do such things as use the toilet and speak normally and had developed some symptoms similar to those of autism, such as obsessive behavior and difficulty relating to others. (While lead poisoning is not currently recognized as a cause of autism, lead-poisoned children may have symptoms similar to those of children with autism.) Now 12, he is physically and verbally aggressive and has a host of learning problems, including difficulties with math and writing—he hasn’t mastered script, and he prints letters backwards—as well as with retaining information.
“He’s a very slow learner; you have to teach him something over and over,” says Kristin. “He went to regular school through second grade but kept falling further further behind.” Finally, Kristin, a former special-education teacher, began home-schooling Michael. Thought they’ve made progress, Kristin worries about the future of a 12-year-old who still can’t tell time. “He’s starting to hit learning plateaus. I don’t know what will happen to him as he gets older,” she says.
Changing the system
Hoping to help other parents avoid going through what she did, in 1999 Susan founded the nonprofit Maine Lead Action Project, an advocacy group that works with community organizations across the state. Earlier this year her group was instrumental in the Maine legislature’s passing a bill that calls for lead screening of all 1- and 2-year olds.
Through it all, Susan has felt guilt, fear, and sadness, but she has felt something else too: anger. “The burden is placed on the parents to get the lead out of our homes. But we didn’t put the lead there,” she says. She wishes, for instance, that lead tests had been part of the permit-granting process when she and Greg started their renovation or that abatement had been mentioned as an option early on. “There are so many preventive steps that could have been taken along the way.”
Experts agree that the best way to prevent lead poisoning is to look for lead in houses before it gets into children. Unfortunately, unless you have your house or apartment professionally inspected for lead, it’s difficult to know whether it’s safe. Though owners of pre-1978 housing are now required by law to disclose known lead hazards to prospective buyers or tenants, owners and landlords have no incentive to find out if lead hazards exist.
“The focus should be on government agencies and local groups to identify and fix properties,” says Eileen Quinn, deputy director of the Washington, D.C.-based Alliance to End Childhood Lead Poisoning. “It shouldn’t be on parents’ shoulders.” Of course, finding lead and clearing it out of homes takes money, so some local governments are trying to recover funds for lead abatement by bringing lawsuits against the lead industry—including paint companies, such as Sherwin Williams, and chemical companies, such as American Cynamid.
“Childhood lead poisoning is a totally preventable disease,” says Rosen. “In an ideal world, all the lead-based paint in housing would be removed, and that would wipe out the disease forever.”
Her own abatement complete, Susan looks out at the flower-filled deck she and Greg built to cover lead-filled dirt, while Sam and Alexandra watch Thomas the Tank Engine (Sam’s favorite) in the next room. “I meet parents who are embarrassed to say this happened to them, because [they think] it means they’re not keeping the house clean,” she says. “This is not about parenting or housecleaning. This is a public health and housing issue that is preventable. Parents shouldn’t be embarrassed; they should be outraged.”