January 16th, 2017

Exposure to lead and its health consequences in children attracted a lot of attention from The PediaBlog in 2016. Nine separate posts, including a week-long series in January (beginning with a chemistry lesson here), uncovered an old scourge up to new tricks — lead poisoning from contaminated drinking water in Flint, Michigan. Pittsburgh’s water supply, as well as water systems in other cities, also received much-deserved scrutiny. But in this region of the country, like in most others, the risk of exposure comes primarily from lead-based paints used on the inside and outside of homes before they were banned in 1978:

Old, deteriorating lead-based paint remains the dominant threat of lead poisoning to children who live, learn, and play where paint peels, chips, or turns to dust.


As lead accumulates in the bodies of children who are chronically exposed to it, even at low levels, the damage it causes is unforgiving:

Lead acts very much like calcium in the bloodstream, so it tends to build up in bone. Children’s growing bones are metabolically active to the extreme, so lead doesn’t stay there for long. Instead, it travels to other metabolically active and growing organs, particularly the brain. It is here that lead, a natural heavy metal, can do the most unnatural damage.

The injuries caused by lead in a developing child’s brain may be profound, or it may be subtle, but it is always permanent. We know that brain damage from lead causes lower IQ’s and other cognitive delays, learning disabilities, hearing impairments, difficulties with attention and concentration (ADHD), decreased academic achievement, and anti-social and other behavioral problems. All these effects have life-long consequences for children when they become adults, and for the rest of society.


It’s clear that with each passing generation, pediatricians and parents alike worry more and more about the risks of pollution on the health of children. And the reasons why are obvious — our developed society continues to spill chemicals and fumes into our shared ecosystem (air, water, soil) and add them to food and consumer products. Over time, these toxics add up because, as we’ve stated the obvious here several times: “Earth is a closed system — what happens here stays here.” Which brings up an important question that ultimately has an unknowable answer: How much exposure is too much? No one is going to do the unethical, double-blind study exposing different groups of pediatric participants to varying concentrations of substances known to be poisonous to them, to determine how much is too much. Because of what we know about lead exposure and the damage it causes, this much we can all acknowledge: There is no safe level of exposure to lead.

Pittsburgh’s children are considered at high risk for the health effects from exposure to lead, says Don Hopey, because 80% of the residential dwellings were built before 1978 — the year the Environmental Protection Agency banned the use of lead in interior and exterior paints. This makes last week’s announcement by the Allegheny County Health Department on mandatory lead testing in children so important.

The draft regulation, approved by the health board on a unanimous vote Wednesday, would require that children be tested for lead between 9 and 12 months old, and again when they’re 2 years old. The results would be added to the immunization report schools are required to make to the county health department when the children enter kindergarten or grade school.

The policy, which is part of a more robust county effort to identify and mitigate childhood lead exposure issues, is aimed at giving the health department a better idea about how many children have high lead levels, were they live and how they were exposed.


Allegheny County is the first in Pennsylvania to consider universal lead testing in the pediatric population in order to prevent the slow motion disaster of lead poisoning. So far, eleven states mandate lead testing — something Pennsylvania has recently considered. But to its credit, Allegheny County isn’t waiting:

A recent study published in the Journal of Pediatrics revealed that Pennsylvania has the second highest proportion of children with elevated blood lead levels (Minnesota was first). More than 5 million pediatric blood samples sent for lead testing were analyzed nationally and… Pittsburgh didn’t do so good.


If the Allegheny County Council approves, universal lead testing will begin next January.


(Disclosure: I was one of several Pittsburgh-area pediatricians asked last summer to lend input into this recommendation for universal lead testing.)


(Google Images)


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    Ned Ketyer, M.D.

    Ned Ketyer, M.D.

    Dr. Ketyer has special interests in developmental pediatrics and preventative medicine, specifically how nutrition and the environment affect health. He earned his bachelor’s degree from the University of Vermont and his medical degree from Northwestern University Medical School. He completed his residency at Children’s Hospital of Pittsburgh.

    As one of the founding physicians of Pediatric Alliance, PC, Dr. Ketyer served as its president from 1997-2004. He has been practicing general pediatrics at Pediatric Alliance since 1990. Dr. Ketyer and his wife have three boys and live in Pittsburgh's South Hills. 

  • Note: The information included in these posts is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice.

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