CHILDHOOD LEAD POISONING PREVENTION PROGRAM

Jasper County Health Department runs a Childhood Lead Prevention Program funded by the EPA. This program provides free case management and environmental services to Jasper County families who have children with elevated blood lead levels and also provides blood lead testing for children between the ages of 6 and 72 months and for pregnant or nursing mothers. Testing is provided at the Jasper County Health Department, the Joplin City Health Department, and even at the home of the client if transportation is a concern. An appointment is needed for this test. We are also available to participate in Health Fairs and other public events and can offer lead testing on site.

Children should have a lead test once a year beginning at 6 months of age until they reach 6 years of age. This is recommended because of the tendency of children in this age group to put many items in their mouths and to have poor hand washing habits. Lead enters the body through hand-to-mouth activity or through ingestion from another source. It can also enter the body by being inhaled in dust form. This is seen most often in adults who are conducting remodeling activities. Children, however, who are present when these activities are taking place, could also inhale these particles and are likely to find a way to ingest lead dust created by these activities. For example, if an adult was sanding old lead paint which was creating a dust, a 9 month old child may crawl across the floor and get the dust on their hands. From here a child of this age is highly likely to put their fingers in their mouth and get lead into their system. Other common sources of lead poisoning are lead contaminated soil, chipping or peeling paint in the home or a residence the child visits frequently, water, or other items in the home.

Blood lead tests are important because there is no other way to confirm that a child has lead poisoning. Many of the symptoms of lead poisoning are often confused with symptoms of other illnesses. If lead continues to enter the body and/or is present within the body for a long period of time, it may cause lasting harm to the brain, kidneys and nervous system.

The blood lead test consists of taking a very small venous blood sample. If there is difficulty in locating a good vein for this purpose, a finger prick sample may be obtained; however, the venous sample is preferred because it is more accurate and often faster and less painful for the child. If the lead level in the blood is found to be greater than 3.5 micrograms per deciliter, the Childhood Lead Prevention Program will offer case management services until the child receives two consecutive blood tests below this level.

Case management services consist of a home visit by our lead nurse who will provide lead education and also, our environmental health specialist for the lead program may be able to offer an environmental assessment of your property. This includes testing of the soil, paint, water and dust on the property for lead contamination to determine where the child may have come into contact with lead. It is very important for the family to know the source of lead in order to prevent the child from becoming poisoned further. Once the sources of the lead are determined the environmental specialist can work with the family to help find ways to make the problem areas inaccessible to the child or to give advice on proper control and abatement measures.

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AUTHORIZATION FOR TREATMENT FILE

SOURCES

In a residential setting there are three main sources where lead may be found. These are water, soil and paint. Each of these can be tested during an Environmental Assessment to determine if there is lead present. The Health Department provides this service at no cost for children who are residents of Jasper County and who have an elevated blood lead level.

Water is seldom found to contain high levels of lead in Jasper County but samples are always taken for analysis during an Environmental Assessment because it is a possible source. Well water is more likely to contain lead, however; it is still uncommon to find well water contaminated with lead in this area. Although city water is even less likely to contain lead, there is still a possibility that it could be contaminated due to the plumbing in the home. Well water can also become contaminated due to plumbing. Many older homes have lead pipes or contain other plumbing components with lead solder. Also plumbing fixtures made of brass or bronze may contain lead. Because the water in our area contains a large amount of mineral, it is common for the inside of the pipes to be coated with a thick layer of mineral which prevents the water it carries from ever coming in contact with the pipes. This may be an inconvenience in some cases, but it does help to reduce the risk of lead contaminated water in older homes.

Lead contamination in soil is a major concern in this area because of the mining and smelting that were major economic activities in this county for about 120 years. Lead from smelting has settled out of the air and into the soil in some areas. Mining waste that was left above ground has spread around and in some cases has even been used in sandboxes or as material for driveways or foundations. Some soil has also become contaminated with lead from paint containing lead which has chipped off of buildings and fallen into the soil. Soil near very busy streets may also contain lead from the use of leaded gasoline in automobiles during the early 1920's into the 1980's. During an Environmental Assessment, small amounts of soil are taken from near the surface to be analyzed for lead content.

Until 1978, when commercial use was outlawed, it was very common for house paint to contain lead. Leaded paint could last longer, be more brightly colored and resist fading and mildew. Because of this it was commonly used on the exteriors of buildings and around windows and doors. Unfortunately its use has been very widespread and it is poisonous if it enters the body. Most houses built before 1978 contain some lead paint. If the paint remains intact it would not be considered a hazard; however, if the paint begins to chip or peel it could potentially harm occupants of the home. Lead paint has a sweet taste and a young child may be likely to eat the chips of paint if they discovered the sweet taste. Small children may even chew on a painted surface such as a window sill. Also, if dust was created from the lead paint it would be fairly simple for the dust to get onto the hands of a child and then into their mouth. Dust can be created when the paint chips, or, more often, from the friction created when door or window components rub together when being opened or closed. Also, dust can be created during remodeling or sanding activities. The Jasper County Health Department has a machine that can test the lead content of paint within seconds without disturbing the painted surface.

Besides these three main sources of lead here are several other places lead may be found in the home:

Toys
Jewelry
Porcelain or pottery especially imported
Food stored, baked or served in poorly glazed pottery or leaded crystal
Food packed in cans with lead seams (no longer used in U.S.)
Food grown near sources of lead
Imported or homemade food, candy, or folk medicines, or cosmetics
Dust on clothing, shoes or hands of someone who has an occupation or hobby using lead
Antique pewter
Drapery and window weights
Imported plastic blinds
Plastic coatings on wiring
Imported plastic Christmas trees
Fishing weights
Battery casings

SYMPTOMS

Most children with lead poisoning show no symptoms. A parent may not realize their child has a lead issue until they have the child tested. Fortunately, prompt attention can limit the effects of the lead exposure. Symptoms that may be seen in children with lead poisoning but are commonly mistaken for other illnesses include:

Difficulty sleeping

Poor appetite

Weight loss

Stomach aches

Vomiting

Constipation

Joint Pain

Headaches

Concentration Difficulty

Restlessness

Irritability

Weakness

Tiredness

Diarrhea

Blindness

Convulsions

Fainting

Dizziness

Staggering gait

Low lead levels in children may cause problems with the nervous system and brain. Problems that may occur include interfering with growth, harming hearing, lowering IQ levels, causing behavioral issues and making learning more difficult. In addition, the child may become anemic. High levels of lead poisoning may result in convulsions, kidney failure, a coma and even death.

TREATMENT

The first step in determining if you child has lead poisoning is to complete a blood lead screening test. This screening can be completed through the Jasper County Health Department's lead program or with your child's pediatrician. The two methods available for completing the screening are a capillary test (sample from a finger) and a venous test (sample from a vein). The latter is the most accurate. If you choose the capillary test and it is elevated a venous test must be completed in order to confirm the accuracy of the capillary test. Capillary test results may show a higher level of lead than what is actually present in the blood stream since it is possible for lead particles to remain on the finger even after it is cleaned in preparation for the test. Once the blood sample is obtained it will be sent to a lab for testing (see lead poisoning chart levels below). If a child is elevated a parent needs to determine the source of exposure and limit access to that exposure.

The lead program can assist parents in determining the sources of exposure by completing an environmental assessment of the child's home. If a child is undergoing treatment for lead poisoning it is also important to follow prevention tips to stop more lead from entering the body. Children who have lead poisoning should get at least three meals a day because full stomachs are less likely to absorb lead. Providing a diet high in Iron, protein, vitamin C, calcium, and low in fats/oils is essential for a lead poisoned child to be able to rid the body of lead as quickly as possible. Also, provide a daily vitamin supplement to ensure that the child is getting all the proper nutrients needed. A physician may prescribe a medicine (Chemet) to help rid the body of lead; however, typically the level must be greater than 44mcg/dL. While the child is taking Chemet the physician will complete lab tests to ensure the medicine is not harming organs in the child's body. During the chelating therapy the child should not be returned to the environment where the lead hazards are present until it has been controlled.

This medicine does not prevent lead from re-entering the body, therefore the source must still be found and the exposure limited. The Jasper County Health Department lead program can provide case management if the elevated child is 6 months to 6 years of age. Case management consists of the lead department providing a home visit to the child's home, free of charge, to educate the family on lead poisoning and completing an environmental assessment (obtaining water, soil, and dust samples and testing painted surfaces in the home) to determine where the exposure exists. In order to complete an assessment of the property the elevated child must have resided at the address for 3 months or more. If the child has not resided at the address for this amount of time, a visual walk through assessment and education may be completed, but no samples would be taken at that time. Once the child has resided at address for 3 months then a full environmental assessment may be completed. Prior to completing the environmental assessment, a letter will be sent to the property owner informing them of the date and time that the environmental assessment is scheduled to take place. At lower levels, owner approval must be obtained for visual or full environmental assessments. Once the environmental assessment is completed the environmental specialist will send samples to the lab and, when results are obtained, will provide a written report of the findings to the child's parent and property owner. The lead department will close case management on a child when 2 consecutive non-elevated results are obtained and will encourage yearly screening until the age of six.

Blood lead levels are measured in “micrograms” of lead per “deciliter” of blood, or “mcg/dL.”

Jasper County Health Department now uses the new CDC Blood Lead Reference Value of 3.5mcg/dl. The Childhood Lead Prevention Program will close case management on a child when 2 consecutive non-elevated results are obtained and will encourage yearly screening until the age of six.

Follow up Venous Blood Lead Testing Schedule

0-9 mcg/dL - No further action. Rescreen as recommended.

10-14 mcg/dL - Get follow-up testing within 3 months. Get lead education and information on available services.

15-19 mcg/dL - Get follow-up testing within 2 months. Get lead education and information on available services.

20-44 mcg/dL - Get complete medical evaluation and care. Find and get rid of lead hazards in the child’s home, school and play areas.

45-69 mcg/dL - Within 48 hours, begin medical evaluation/care and inspection for and removal of lead hazards.

70 mcg/dL or above - Medical emergency. Get immediate medical treatment and inspection of environment.

PREVENTION

The prevention of lead poisoning seems very simple when you realize that all you have to do is avoid eating lead or breathing in lead dust. However, if you are living in a home that has lead in the water, soil, paint or other sources this can be more difficult. The following list contains just some of the ways to prevent lead poisoning. If you know or suspect that you are living in a home with lead hazards, please contact the Jasper County Health Departments' Childhood Lead Prevention team for more information on precautions you can take.

PERSONAL HYGIENE

One of the simplest ways to keep yourself and your family safe from lead is to practice proper hand washing techniques. If there is lead on your property, chances are there is lead dust in your home from friction surfaces or from contaminated soil. To prevent this dust from being swallowed it is a good idea to wash your own and your children's hands frequently, especially before preparing or eating food , after playing outside, after playing in or around windows or doorways, after crawling on the floor, after handling outdoor toys or anytime they look dirty. Another thing to be cautious of is letting children put a dropped bottle or pacifier back in their mouth before it has been cleaned well. If you have a job or hobby that brings you into contact with lead, lead can be carried into your home on your skin and hair, clothing and shoes. If shower facilities are offered at work, use them and put on clean clothing before coming home to your family. If not, try to remove your work clothing in a laundry room and place the clothing directly into the washing machine to be washed separately from children's clothing. It is also a good idea to remove shoes before entering your house. Shower before you make physical contact with the rest of the family.

SOIL AND DUST

To help reduce the potential for getting lead poisoning from contaminated soil and dust, try to minimize contact with these sources. Plant bushes or use mulch or rock to cover contaminated soil in the drip zone of the home to make the soil inaccessible. Plant grass seed in bare soil areas, avoid walking on bare soil areas, keep children from playing in these areas and from digging in the dirt. Use welcome mats at entryways to the home to reduce the amount of soil brought in on your shoes. Wash hands after contact with pets that may have lead dust in their coats from being in contaminated soil. Inside the home, frequently clean the entryways and window sills using a wet cleaning method. Dry dusting or sweeping can spread lead dust and introduce it into the air causing more of a hazard. Using mops or wet clothes and rinsing them out thoroughly and frequently during use will actually pick up and remove lead dust rather than spreading it around. Use a HEPA filter vacuum if one is available. If you are cleaning an area known to contain lead dust and do not have a HEPA filter vacuum, one is available for loan at no cost at the Jasper County Health Department.

Follow these tips anytime you are visiting a place that you do not know to be free of lead such as the home of a relative or a community park or at home when you know or suspect that there may be lead hazards. This will greatly reduce the likelihood of getting lead poisoning.

WATER

If your water is found to contain lead, do not drink or cook with your water until you receive test results showing that the lead level is within the recommended limits for lead in water. You may be able to find a filtration system that is specifically designed to remove this type of contamination, but be careful not to spend your money on a system that will not do what you need. Many filters and water softeners are available that will do nothing at all to remove lead from your water. If the problem is found to be in the plumbing, an option would be to replace the old plumbing. If the problem is from well water it may be necessary to have a new well put in. It is safe to use this water for washing clothes, bathing and showering, but be careful to ensure bathing children

do not drink the water.

REMODELING

When performing any remodeling activities in a home built before 1978, it is best to take precautions to limit exposure to lead paint or dust. The Health Department recommends that licensed lead abatement workers perform remodeling or remediation work done on a home built before 1978. This is especially true when there is known or suspected lead paint or when children are present. If you must do the work yourself, take precautions. Keep children away from remodeling activities! Completely out of the home is best. Work on one room at a time and keep that room blocked off from the rest of the home with plastic sheeting. Be careful not to track lead dust into the rest of the home on feet or clothing. Remove furniture and other objects from the room that may not be easily cleaned when the remodeling is complete. If sanding or scraping must be done, use a misting bottle to wet the paint first to reduce the amount of dust created. Always wear a mask. The most common way for an adult to get lead poisoning is through breathing in lead dust during remodeling. Clean each room thoroughly before taking down the plastic and moving to another room in the house. Be sure that all traces of dust have been removed using a wet cleaning method and/or a HEPA filter vacuum. Call the Jasper County Health Department Childhood Lead Prevention team with any questions or for more information on safely remodeling or removing lead from your home.

LINKS

This EPA website will give you additional pamphlets and information regarding lead.
www.epa.gov/lead

This CDC web site give you more information regarding the Lead Poisoning Prevention Program run by theCenter for Disease Control, including their resource library.
www.cdc.gov/nceh/lead

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