Families are skipping well-child visits to pediatricians, who say that could pose major health risks.
By Greg Barnes
The coronavirus pandemic has resulted in thousands of families skipping or delaying well-child visits to pediatricians, where many children would have been tested for lead poisoning or received vaccinations.
A survey of pediatric offices across North Carolina taken near the beginning of the pandemic found that 85 percent reported a patient decrease of 40 percent or more, said Elizabeth Hudgins, executive director of the North Carolina Pediatric Society.
“What we’re hearing anecdotally is that that is picking up, but, you know, it would have to be through the roof to make up for all the lost ground,” Hudgins said.
Figures from the state Department of Health and Human Services bear that out.
In April, the number of lead screenings in North Carolina had declined 52 percent from the previous year, DHHS spokeswoman Sarah Lewis Peel said in an email. Peel said the decline has since been reduced to 24 percent.
Children in North Carolina whose parents are on Medicaid are required to be tested for lead at 12 and 24 months of age. The Centers for Disease Control and Prevention and North Carolina recommend that all children be tested at those ages.
A child who tests positive for excessive lead levels — above the reference value of 5 micrograms per deciliter — faces a risk of adverse and irreversible brain development, lower IQ and damage to the kidneys and nervous system. High levels could lead to seizures, unconsciousness and death, according to the Mayo Clinic. Researchers say no lead in the human body is safe.
No outward signs
Young children with high lead levels typically don’t exhibit early signs to their parents. That’s one reason that skipping a pediatric visit where a lead test would have been conducted has serious ramifications, said Jennifer Hoponick Redmon, a senior environmental health scientist and chemical risk assessment specialist with RTI International in Research Triangle Park.
When a child is found to have a high lead level, it triggers a government investigation to determine and eliminate the source and stop additional exposure, Redmon said.
“What typically happens is [public health officials] go in and then they look for lead paint. They will look for lead in water… They’ll look for lead in dust, spices, toys and soil. They’ll basically do a housing inspection, a yard inspection,” Redmon said. If the child is enrolled in a child care center, she said, they will inspect that, too.
Primary sources of lead poisoning include paint and tap water, particularly in older homes. Redmon said it’s uncommon for drinking water to be contaminated with lead at a municipal source or in a private well.
Historically, she said, lead exposure comes from a home’s paint, household dust, or contaminated soil in the yard. Lead was banned in paint for residential use in 1978 and phased out in gasoline by 1995.
Another key source of lead in households is plumbing, faucets and fixtures, especially in homes built before 1986. That’s when Congress amended the Safe Drinking Water Act, reducing the allowable amount of lead in pipes, solder and flux.
Other sources of lead
Dr. David Hill is a pediatrician at Goldsboro Pediatrics. He is also an author and a recognized authority on childhood health and development.
Hill said lead poisoning doesn’t always stem from old paint or contaminated tap water. It can come from the hands or clothes of a parent who works in an industry where lead is prevalent. It can come from old toys or from long-ago uses of lead in someone’s backyard, because microscopic residue of the metal can persist in the soil. Even jewelry and cosmetics can contain lead, he said.
“The reason that young children are so susceptible is that they tend to spend a lot of time on the ground putting things in their mouths,” Hill said. “So if you’re down there where the paint chips and the dust are and you tend to put a lot of things in your mouth, you’re much more susceptible to lead poisoning.”
The CDC estimates that 500,000 children between the ages of 1 and 5 have lead in their systems above the reference value of 5 micrograms per deciliter, the level the CDC recommends that public health actions be initiated. An even lower reference dose is being contemplated.
In times past, medical researchers tolerated much higher lead levels in children before becoming alarmed. But toxicological research showed that even minute levels of blood lead can lead to long term problems.
Two years ago in North Carolina, 548 children ages 1 and 2 were found to have lead levels above 5 micrograms per deciliter. Of those, 147 had levels above 10 micrograms per deciliter, according to the state Department of Health and Human Services.
“Families with financial needs sometimes are more exposed to older housing or live in neighborhoods that were previously industrial facilities,” Hill said. “However, absolutely any child can be accidentally exposed to lead from surprising sources. So it’s important to know that the only way to really reassure yourself that your child is safe is to get that recommended screening at age 1 and 2.”
Who is most at risk?
Studies have shown that Black children are nearly three times more likely to be poisoned by lead than whites.
And families with their first newborn are more at risk of the child developing lead poisoning during the pandemic, Redmon said.
“For new babies that do not have older siblings, you know, parents may not understand or know that there’s lead exposures,” she said.
Redmon said a child could also be at greater risk during the pandemic because of changes in the family’s daily routine.
“Maybe they previously were at a child care center, but now they’re at, you know, somebody’s home across the street that can help while parents are working,” she said. “So if there are changes in their habits, that could lead to a change in lead exposure that’s not being caught without these blood tests.”
Redmon said North Carolina is trying to become proactive, finding and eliminating sources of lead before they can harm children. She said she and other researchers are now engaged in a project to detect lead sources across the state, including in older and poorer communities.
Redmon is the project director of the state’s “Clean Water for Carolina Kids” program, which earlier this month won Harvard University’s prestigious Roy Family Award for Environmental Partnership.
“Clean Water for Carolina Kids” is a partnership among RTI International, NC Child, the Duke Environmental Law and Policy Clinic, and the North Carolina Division of Public Health. It aims to protect children and infants from exposure to lead in drinking water at licensed child care centers and Head Start pre-K programs in public elementary schools.
Last year, the partnership’s work led to a state requirement that licensed child care centers and pre-K programs begin testing for lead in their tap water within a year. Redmon said that while testing continues at centers that remain open, the time limit has been informally relaxed because of the pandemic.
But some testing has been completed, including at one child care center in Richmond County where the lead level measured 3,930 parts per billion at one cafeteria faucet. The American Academy of Pediatrics’ reference value for lead in drinking water is 1 part per billion, which is far less than the CDC’s value.
According to Redmon, the center’s owner said she provides bottled water to the children, and the water from the faucet was used primarily for mopping floors.
An estimated 230,000 children attend nearly 4,600 licensed child care centers across North Carolina.
North Carolina leading the way
There is some good news, though. The number of children ages 1 and 2 who are being screened for lead is steadily rising, from less than 25 percent in 1995 to nearly 55 percent by 2017, according to state data. In that same timeframe, the number of children found to have lead levels above 5 micrograms per deciliter fell sharply.
The percentage of children being tested in North Carolina is higher compared with other states nationwide, said Peel, the DHHS spokeswoman. In 2018, she said, 57 percent of all children ages 1 and 2 were tested in this state.
Among the reasons for the higher screening rate, Peel said, is that North Carolina has been aggressively pursuing universal testing much longer than other states, especially those in the Southeast. The State Laboratory of Public Health has offered free lead screening for children under age 6 since 1994, she said.