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General Information


What is lead poisoning?

What are sources of lead exposure?

What are the symptoms of lead poisoning?

What are the adverse health effects of lead poisoning?

How to reduce or prevent lead poisoning?

Blood lead screening and testing

Lead Exposure Risk Assessment Questionnaire (LERAQ)

 


What is lead poisoning? 

Lead poisoning is a condition caused by exposure to lead resulting in high blood lead levels. Lead is a metal that occurs naturally in the environment. Although it has many beneficial industrial uses, it is harmful to humans when ingested or inhaled.  There is no safe level of lead in the body.  It is particularly harmful to the developing brains and nervous systems of fetuses and young children. This is especially true during the critical development periods of early childhood. Young children are most vulnerable to the effects of lead because they absorb a greater percentage of lead as they quickly grow and develop.   

Lead is highly toxic and is found in many products in and around the home. You cannot see, taste or smell lead, so it may be in your home environment without your knowledge. It is generally found in paint, dust or soil in or around older housing, particularly housing built before 1950 or between 1950 and 1978. However, there are other sources of lead exposure as well which could result in lead poisoning.

Blood lead levels are measured as micrograms of lead per deciliter of whole blood (µg/dL). Although there is no scientific evidence on a safe level of lead in the blood, the Centers for Disease Control and Prevention (CDC) has revised their reference level for children 6-72 months of age at from 10 µg/dL to 5 µg/dL.  The reference level refers to a blood lead level at which recommended specific interventions should be implemented to reduce the blood lead levels in the body.

 


What are sources of lead exposure?

Lead-Based Paint and Lead Contaminated Soil and Dust

Although lead is no longer used in paint, gasoline and many consumer products, some sources of lead still exist and thus pose a health hazard.

The most common risk factor for childhood lead poisoning is the deteriorating residential lead-based paint which is found in almost all housing units built prior to 1950, as well as lead contaminated dust and soil. Lead-based paint was banned for use in 1978, which means that all houses built before 1950 and many built between 1950 and 1978 may have lead-based paint. Children are most often poisoned when lead-contaminated dust gets on their hands or toys and is then transferred to their mouths. Sometimes children may actually eat paint chips or inhale leaded dust.

According to the CDC, deteriorated leaded paint and elevated levels of lead contaminated house dust are present in an estimated 24 million U.S. housing units. More than 4 million of these units are homes to one or more young children.

Lead in Water 

Houses containing lead pipes or pipes soldered or welded together with metals containing lead, may have high lead levels in drinking water. According to the U.S. Environmental Protection Agency (EPA) homes built before 1986 are more likely to contain lead pipes, fixtures and solder. Lead enters tap water through corrosion of plumbing. Corrosion is a reaction between the water and the lead pipes or solder. Dissolved oxygen, low pH (acidity) and low mineral content in water are common causes of corrosion.

Take-Home Sources and Hobbies

It is important to note that children can be exposed to lead hazards through “take home” sources. In other words, lead particles brought home on the clothes, shoes or hands of an adult who works in an occupation that exposes him/her to lead. At work, people are usually exposed by breathing in air that contains lead particles. Families of workers may be exposed to higher levels of lead when workers bring home lead dust on their work clothes and shoes. 

Work that involves industrial painting (such as bridges, water towers), cable splicing, construction, mining, radiator repair, recovery of gold and silver, repair and reclamation of lead batteries, smelting, welding, working on firing ranges and oil fields, and manufacturing bullets, ceramic tiles, electrical components, and lead batteries, are some of the occupations where workers may be exposed to lead.

Children may also come in contact with lead and get lead poisoning through hobbies and leisure activities such as making stained glass, pottery, bullets and fishing sinkers, refinishing furniture and painting.

Lead in Toys

Children may be exposed to lead from toys that have been made in other countries and imported into the United States or from antique toys and collectibles passed down through generations. Lead may also be found in older toys made in the United States. The U.S. Consumer Protection Safety Commission (CPSC) is responsible for announcing recalls of toys which contain excessive levels of lead and could result in adverse health effects.

Recalled toys that show signs of wear (chipped or peeling paint) or have cracked or broken parts are of special concern. Children 6-72 months of age are at the greatest risk from lead exposure and children under 36 months of age are particularly susceptible because of this age group's normal hand-to-mouth behaviors.

A complete list of all the recalled products can be found at the CPSC website. To subscribe to the CPSC's email distribution list to receive bulletins about recalled products, consumers can go HERE

Please also refer to National Center for Healthy Housing (NCHH) fact sheets: Toys and Childhood Lead Exposure and Testing for Lead in Consumer Items for Children for additional information on toys and lead hazards. 

Home Health Remedies, Imported Cosmetics and Pottery

Certain traditional home health remedies contain lead. Greta and Azarcon are used by Hispanic communities to treat upset stomach or indigestion. Pay-loo-ah is used within the Hmong community and given to children as a cure for rash or fever. Certain Asian remedies are also found to contain lead such as Bali Goli, Ghasard, and Kandu. 

Kohl (also known as Kajal or Surma) is used by Middle Eastern and South Asian communities.It is a traditional cosmetic used as an eyeliner, however, it contains high levels of lead.

Lead may also leach into food if it is put into improperly glazed pottery or ceramic ware made outside the United states (especially bean pots from Mexico).

Leaded Mini Blinds

In 1996, the CPSC issued a warning that some imported vinyl (plastic) mini blinds manufactured in China, Taiwan, Mexico, and Indonesia may present lead poisoning hazard for young children. Lead is used as a fixative in the vinyl. As the vinyl deteriorates when exposed to sunlight and heat, it forms lead dust on the surface of the blinds that children can get on their hands and then in their mouths. New mini blinds should always be in a box labelled "Lead Free." Some homes may still have leaded mini blinds installed prior to 1996. 

 


What are the symptoms of lead poisoning?

Children

  • Loss of appetite 
  • Vomiting 
  • Diarrhea
  • Stomach cramps
  • Constipation
  • Learning problems
  • Difficulty in sleeping
  • Anemia

Adults 

  • Stomach pain
  • Fatigue
  • Decreased libido
  • Headache
  • Irritability
  • Muscle or joint pain

 


What are some of the adverse health effects of lead poisoning?

Children

  • Learning disabilities 
  • Language and behavioral problems 
  • Lower I.Q. 
  • Attention deficit disorder
  • Hearing loss
  • Anemia
  • Muscle weakness
  • Damage to nervous system and kidneys
  • Death by lead poisoning is uncommon but can happen

Adults

  • Hypertension
  • Hearing loss
  • Infertility 
  • Anemia 
  • Peripheral neuropathy (damage to nerves supplying sensation to arms and legs) 
  • Damage to nervous system and kidneys

 


How to prevent or reduce lead poisoning?

The most important way families can prevent or reduce lead poisoning is to know about the sources of lead inside as well as outside their homes and avoid exposure to these sources. 

  • If the home is built before 1978, use these tips to avoid lead poisoning from contaminated household dust:
    • Do not sweep paint chips and/or dust or vacuum unless it is with a true high efficiency particulate air (HEPA) filter.
    • Clean floors, walls, and window sills often with a wet cloth or mop, using a high phosphate detergent (such as Cascade powdered dish washing detergent).
    • Wash your child's hands and face often, specially before eating.
    • Feed your child three meals and two or three snacks, which are rich in calcium and iron.
    • Maintain regular visits to your health care provider.
    • Make sure children play in safe areas with no exposed dirt.
    • Wash toys daily.
    • Have your child tested for lead.

  • If you think you have lead in your water:
       
    • Do not use hot tap water for cooking or preparing formula, since it is likely to contain higher levels of lead. Use cold water for cooking.
    • Let the cold water run 2-3 minutes before using for the first time each day. The more time water has been sitting in your home's pipes, the more lead it may contain.
    • Contact the Oklahoma Department of Environmental Quality at 405-702-1000 if you want to have your water tested for lead.

 

  • If your work or hobby involves working with lead, then follow some simple guidelines to protect yourself and reduce the chances of bringing lead contamination home.
      
    • Wash your hands and face before eating, drinking, or smoking. Take breaks away from lead dust and fumes.
    • Wear protective equipment and clothing over your clothes whenever you work with lead.
    • Wear a clean, properly fitted respirator in all areas exposed to lead dust or fumes.
    • Obtain a Material Safety Data Sheet (MSDS) from your supervisor or employer. It will identify materials on the work site that contain lead.

    • Use work practices that reduce your exposure. For example, use cold damp scraping methods to remove paint. Avoid heat guns and power sprays to remove paint.
    • Never use high pressure water or compressed air to clean up.
    • Avoid sweeping work site dust. If vacuuming, use a vacuum with a true HEPA filter.

    • Wash your hands and face before eating or smoking. 
    • Use a damp mop and clean using a high phosphate detergent.
    • Shower and shampoo thoroughly after work (lead dust sticks to skin and hair).
    • Change shoes and clothes before you go home.
    • Launder your work clothes at work if laundry services are provided by your employer.
    • If clothing must be laundered at home, launder them separately from your family’s clothes.
    • Cut fingernails short and clean them carefully.
    • Do not burn painted boards, newspapers, colored paper or magazines in a wood burning stove or fireplace.

 

  • If you suspect that your child has been exposed to a toy containing lead:

 

    • Refer to the CPSC website for pictures or product identification.
    • Any recalled toy should be removed and returned to the manufacturer according to the instructions that are provided on the CPSC web site. Any toys that show signs of wear (chipped or peeling paint) or have cracked or broken parts are of special concern. Suspicious toys should be removed from the child's access immediately. A free e-mail subscription to the CPSC recall list is also available on their web site.
    • Consult with the child's primary healthcare provider for further assessment for blood lead testing. When assessing the child's need for blood lead testing, the provider should use the Lead Exposure Risk Assessment Questionnaire (LERAQ).  

 

  • Avoid using home remedies (such as Greta, Azarcon, Pay-loo-ah) and cosmetics (such as Kohl, Surma)  that contain lead.

 

  • Avoid using imported pottery (especially from Mexico) unless you are certain that they do not contain lead.

 

  • If you think your home has imported vinyl (plastic) mini blinds, replace them with new mini blinds that state on the packaging that they are "lead free."

 


Blood lead screening and testing

  • Most children with elevated blood lead levels (EBLLs) have no obvious signs and symptoms. A blood test is the only sure way to know if your child has lead poisoning.

  • The Oklahoma Childhood Lead Poisoning Prevention Program (OCLPPP) recommends that health care providers assess all children at 12 and 24 months of age with the LERAQ to determine their need for blood lead testing. Any child, 6-72 months of age, should be assessed with the LERAQ if they have never been assessed before.  If you (parent/guardian) answers “yes” or “don’t know” to any of the questions, your child should receive a blood lead test. Contact your health care provider to schedule an appointment for a blood lead test for your child. If needed, the OCLPPP can help you find a heath care provider who can test your child for lead exposure. Please view the LERAQ below to determine if your child should be tested.

  • The first test is a Screening test. Blood is taken from the finger. This is also called a capillary test.  If the result of the capillary test is 5 µg/dL or greater of blood, then the child should receive a venous test (blood taken from the arm). This is called a Confirmatory Test.

  • 5 μg/dL of lead in children’s blood is considered to be the reference level for intervention by the CDC. Recommendations from the CDC say that venous blood specimens are preferred for blood lead analysis. In Oklahoma, as well as in other states, an elevated blood lead level is confirmed with a venous blood test, not a finger stick.
  • Children 6-72 months of age who have a capillary blood lead level of 5 µg/dL or greater should receive a venous blood lead test within 3 months if the level is between 5-14; within 1 month if the level is between 15-19; and within 1 week if the level is greater than or equal to 20.  
  • For a child with an elevated venous blood lead level of 5-19, follow-up blood testing should occur every three months. Venous testing continues until 2 consecutive venous tests at least 3 months apart are below 5 µg/dL. Please refer to the Management Guidelines to see how the OCLPPP currently recommends follow-up testing for children 6-72 months of age.
  • All Medicaid-enrolled children must be tested for lead exposure at 12 and 24 months of age as part of the Early Periodic Screening, Diagnosis and Treatment (EPSDT) services. Parents should remind their child's medicaid provider that a lead test is a required part of the EPSDT service to their child. For additional information about EPSDT services, visit the Oklahoma Health Care Authority - EPSDT page.

Lead Exposure Risk Assessment Questionnaire (LERAQ) - English

Lead Exposure Risk Assessment Questionnaire (LERAQ) - Spanish

 

 

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