Living with lead

To test, or not to test, kids for lead poisoning.

In Spokane, the question is put to parents. Unlike some states, Washington requires no blood-lead testing of children before they start school; parents and doctors are encouraged to assess each child’s level of risk and test accordingly.

But symptoms of elevated blood-lead levels – learning difficulties, behavior problems – don’t show up until years after the child is poisoned. Risk factors can seem contradictory (living in low-income housing may put you at higher risk, or not) or insidious (lead, left from historic mining practices in Idaho’s Silver Valley, washes up on Spokane River beaches).

And while the federal government recently lowered the level at which a child’s lead level is considered a “concern,” studies have found even lower levels can affect a child’s IQ.

Blood-lead tests require a sample of the child’s blood, gathered by pinprick or needle.

Paul Trautman, who runs the city’s lead-hazard program for housing, said he believes many children under 6, to whom lead does its worst damage, are living in conditions that put them at risk. But because few are tested – in Spokane County, only 7.4 percent of those born in 2007, according to state data – many have lead-related problems that go undetected, he believes.

“Lead poisoning doesn’t show up as a dramatic problem,” Trautman said. “They don’t have a stamp on their head that says, ‘I’m lead-poisoned.’ ”

Without testing, you can’t tell if a surface in a home – a door frame, a windowsill – has lead in it, said Shannon Meagher, director of community building for Kiemle & Hagood Co., a real estate company that manages the city’s programs to reduce lead hazards in homes. And without testing, she said, you can’t tell if a child has an elevated blood level until their neurological damage shows up years later.

“You could get lead-poisoned at 5, and the fallout could be at 20,” Meagher said.

Old houses, polluted beaches

In Spokane, 81 percent of the homes were built before 1978, the year the government banned lead paint in homes.

That large supply of old housing was one reason the Lands Council, a Spokane-based environmental group, applied for a grant from the Environmental Protection Agency to screen children for elevated blood-lead levels.

“We knew there were a lot of old homes in Spokane, so the risk of lead poisoning was there,” said Kat Hall, of the Lands Council – especially for low-income families, less likely to pay for home repairs to reduce the danger.

Hall listed other potential sources of lead in the environment: the Spokane River, where waste left from Idaho mines accumulates on beaches; old industrial sites, such as a contaminated former BNSF Railway Co. yard in Hillyard that health authorities in 2005 warned kids to stay away from; land contaminated with gasoline; and, in outlying areas, soil contaminated with lead from agricultural pesticides.

Hall still runs the Lands Council’s lead screening effort, although it tests far fewer children now, because the two-year grant ended in 2009.

Toting its testing equipment to screening sites, such as Head Start locations, the group has tested 898 children. Of those, two were found with blood levels of at least 10 micrograms per deciliter, the “magic number” that triggered action from health authorities, Hall said.

However, that magic number has changed since the group did the bulk of its testing, during the grant period. In May, the CDC lowered the “level of concern” from 10 micrograms per deciliter to 5. An additional 28 children tested by the Lands Council had blood-lead levels between 5 and 9.9 micrograms, Hall said. That works out to about 3.3 percent of kids tested showing lead levels at or above the government’s current threshold.

But researchers have found that lead levels even lower than the federal threshold can cause learning and behavior problems.

When children breathe in dust containing lead or eat old chips of peeled or scraped paint, their bodies mistake the lead for calcium. They store it in their bones. From there, the lead is released into their bloodstream.

Citing several studies, a recent briefing from the National Center for Healthy Housing noted that there’s no safe level of lead exposure for children. In fact, the rate of IQ loss per microgram of lead per deciliter of blood is greatest at levels below 10 micrograms, the briefing said.

While earlier research has connected higher lead levels with lower end-of-grade test scores for elementary school students, recent studies have shown kids with lead levels as low as 3 micrograms per deciliter perform poorly, too.

‘This is about your home’

Statewide, 8.8 percent of children born in 2007 had been tested for high blood-lead levels by their third birthday, according to data from the Department of Health. Just 0.3 percent of those tested showed elevated levels. Because of the small percentage of children tested, the state warns, the results don’t necessarily represent the actual number of kids with high blood-lead levels.

In Spokane County, 7.4 percent of children had been tested, according to the state data. Fewer than six of them had blood-lead levels of 10 micrograms per deciliter or higher.

Some states, such as New York, Massachusetts and Rhode Island, require that every child be tested for lead poisoning before they enter school. In Washington, the Department of Health says it’s up to doctors to “use their clinical judgment” to decide which kids to test for lead exposure.

The state encourages testing of kids at risk, said Lauren Jenks, a Health Department epidemiologist. Risk factors include living in a house built before 1978 – especially if it’s undergoing renovation – and having a parent who’s exposed to lead at work.

The state policy is a matter of resources, Jenks said. If every child were tested, “we would have a huge number of kids getting tested” who don’t need to be. “We don’t think we would help enough kids that way,” she said.

It’s smarter to spend money and time minimizing lead in children’s environments – such as through housing-improvement programs – and educating parents and physicians about lead exposure so kids truly at risk get tested, she said.

The state includes information about lead poisoning in its mailings to parents of young children as part of the Child Profile system, the state’s immunization registry.

In the past, the state has faced criticism – including from the Government Accountability Office in 1999 – for its failure to enforce a federal law requiring lead testing of children covered by Medicaid.

The federal requirement remains in place, and doctors still don’t test all Medicaid kids for lead, Jenks said. But the law is in the process of being changed, she said; in the future, it will be up to each state to decide whether to require blood-lead level testing for children covered by Medicaid. At that point, the state will be in compliance with federal law, she said.

The current Medicaid rule is based on logic that holds true in many parts of the U.S.: Poorer families, with children more likely to need Medicaid coverage, live in lead-contaminated older homes. In the Northwest, that logic doesn’t necessarily apply, Jenks said. Older homes can be the most expensive ones – kids in higher-income families can be at greater risk of lead poisoning than those living in newer, less-expensive housing.

“This is an environmental issue,” Jenks said. “This is about your home. This isn’t about how much money you make or what health insurance you have.”

No lead program in Spokane

Citing the region’s mining history, the Panhandle Health District in Idaho runs a lead program that includes screenings for children along with educational efforts. This summer it offered pool passes and other incentives to encourage Silver Valley parents to get their kids tested.

Spokane’s health district doesn’t have a lead program, because there’s no evidence it needs one, said Dr. Joel McCullough, health officer for the Spokane Regional Health District.

The available data shows children in Washington face a lower risk of lead poisoning than kids in other states.

The district does no targeted screenings of kids deemed at risk of lead exposure, he said.

While statewide, the vast majority of children haven’t been tested, statistically significant studies show that few of those who are have high blood-lead levels, said Kim Papich, a Spokane health district spokeswoman.

In 1999, interviewers from the Department of Health visited families at home to conduct blood-lead tests. Judging by their results, they estimated that 0.9 percent of 1- to 2-year-olds in the state have lead poisoning. The rate for Hispanic children in Central Washington was 3.7 percent, the highest in the state.

Health officials don’t know for sure, the Health Department’s Jenks acknowledged, that the numbers aren’t low because kids with elevated levels aren’t being tested.

“We don’t know that,” Jenks said. “What we hope is that parents and health care providers are talking about the risks kids have and they’re testing the highest-risk kids.”