Poisoned by their homes: how the US is failing children exposed to lead
Antoinette Catholdi-Dow, a 30-year-old mother of two, first started noticing little bite marks on the window sills in 2015, when her son was about two and a half years old.
The window sills were the perfect height to help her toddler pull himself up to stand and walk. Eventually, Catholdi-Dow would enter the room and catch her son nibbling along their edges.
By this point, her son had already been diagnosed with both autism and pica, which is an eating disorder that causes a person to crave and eat non-food items.
After a few months of this behavior, her mother-in-law suggested a call to the pediatrician’s office to check his blood for lead, just to be safe. Catholdi-Dow, of Attleboro, Massachusetts, initially dismissed her concerns, but began doing research on the internet about how lead, a neurotoxin, can cause behavioral and developmental problems even at low levels. She also read that old homes, like the one where they lived, could have lead-based paint that poses a hazard to young children when it starts to deteriorate.
But when she called her pediatrician’s office with her concerns, she was at first gently rebuffed.
“They were worried that insurance wouldn’t cover it until his three-year [appointment],” Catholdi-Dow said. “But because I had a reason to believe that it could possibly be lead poisoned at the time, they ended up going ahead and doing it for me.”
When Catholdi-Dow’s son had his first blood lead test, the results came back at 24 micrograms per one-tenth litre of blood – almost five times higher than the reference point the US Centers for Disease Control and Prevention (CDC) uses to recommend a lead intervention.
More comprehensive tests to confirm lead exposure found that her son’s lead levels had actually reached 49 micrograms per one-tenth liter of blood (49 µg/dL) – almost 10 times higher than the CDC’s intervention threshold. He was immediately hospitalized at Boston children’s hospital.
In the meantime, a lead abatement team also visited their home, which had been in her husband’s family for three generations. They found lead hotspots on the door frames, window sills, and in her son’s bedroom closet.
“My husband’s family had grown up in the house, so I didn’t even think twice about it being safe or not safe,” Catholdi-Dow said.
Catholdi-Dow, like many other Americans, likely assumed that lead was a hazard that endangered only previous generations. After all, the federal government had begun reducing lead in gasoline in 1972 and banned its use in paint for homes in 1978.
Making things more confusing is that the history of the rise of lead in American manufacturing, as well as its eventual phase out, is often framed as a public health victory already won.
But this national narrative obscures a horrifying truth about lead, which is that sudden mass exposure can happen anywhere, anytime – as it did in Flint, Michigan when improperly treated water began corroding lead pipes and releasing harmful chemicals into the tap water in 2014. And due to a complex mix of factors including the various competing pressures on physicians and weak regulations about how to report this data, there is no federal system that can quickly identify lead exposure emergencies as they happen. Dr Mona Hanna-Attisha. Photograph: Doug Pike/Hurley Medical Center
When it comes to lead exposure in America, we still don’t have a clear picture of how many children are being exposed to the neurotoxin and where they are. This leaves hundreds of thousands of children vulnerable to the dangers of lead, and compounds inequality in the form of cognitive and behavioral deficits that can hamper communities for generations.
Experts say that it’s possible to eradicate lead from American infrastructure, but that we don’t prioritize it.
“We are currently doing things backwards [by] using children’s blood as detectors of environmental contamination,” said Dr Mona Hanna-Attisha, the pediatrician who famously uncovered elevated levels of lead in her pediatric patients and linked it to a new water source in Flint, Michigan. “The screening that needs to happen is in the environment before children are ever exposed.”
Why lead is so dangerous
Lead is a naturally occuring heavy metal valued for both its affordability and malleability. People have used lead to make cosmetics, drinking and eating vessels, aqueducts and more since the days of Ancient Rome (the word “plumbing” comes from the Latin word for lead, plumbum)
People from the ancient world also knew that coming into direct contact with large amounts of lead was harmful, and linked to forgetfulness, melancholy and insanity. But this didn’t stop manufacturers in America and other countries from using lead compounds in pipes, paint, food cans and gasoline at the turn of the 20th century.
All of these industrial uses put lead particles in the air, in homes and in food and water. In Europe, France, Belgium and Austria were among the first countries to ban it in interior paints in 1909.
By 1924, independent American scientists understood that lead in gasoline posed a lethal hazard to the workers making gas, as well as a more subtle but chronic danger for people breathing in car exhaust and factory emissions.
But it wasn’t until the early 1970s that Congress overcame intense industry opposition and began slowly banning the use of lead-based paint in federal housing, removing lead from gasoline and setting limits on the element in drinking water. It was a long process; lead wasn’t completely banned from gasoline until 1996.
The US is still grappling with how to remove lingering lead from the environment. Last Friday, the Environmental Protection Agency finalized new regulations that would drastically cut the levels of acceptable lead in dust in public housing, hospitals and schools built before 1978.
By 1976, the blood lead level of the average American child between one to five years old was estimated at 15 micrograms per one-tenth litre of blood , or what is now three times the CDC’s current intervention threshold.
Scientists would eventually discover that lead exposure during childhood can destroy brain cells, disrupt communication between neurons and shrink the prefrontal cortex, which is the part of the brain that helps with complex decision making, emotion and aggression regulation and impulse control.
Nationally, chronic lead exposure in the US has been linked to everything from a significant loss of IQ points to a rise in violent crime to billions of dollars lost in future earnings and tax revenue. There is no “safe” level of lead, and its effects are irreversible. The only treatment that doctors have at their disposal, chelation, is not used except in extreme poisoning cases.
Young American children nowadays have an average blood lead level of about one microgram per one-tenth liter of blood (1 µg/dL). We know this because every year, a small but representative sample of about 5,000 Americans are picked randomly to answer surveys and undergo physical exams that will give health officials an overall picture of the nation’s health – including how much lead is in people’s blood. This sample is known as the CDC’s National Health and Nutrition Examination Survey (NHANES).
But this national average tells a deceptive story about the risks that environmental lead still pose to children.
The CDC estimates that there are more than half a million children in the US like Catholdi-Dow’s son who have blood lead levels at or above the CDC’s reference value for intervention. They are concentrated mostly in low-income communities throughout the country because they are the ones who are most likely to live in substandard housing. An estimated 23m housing units in the US have at least one lead-based paint hazard – 3.6m of which are homes for children under six years old.
Making matters even worse is that the US does not have a robust surveillance system that can find these at-risk children and track potential emergencies like the 2014 one in Flint, Michigan, said Eric Roberts, a research scientist specializing in lead exposure at Public Health Institute, a not-for-profit health research organization.
Indeed, the Flint, Michigan lead exposure crisis was uncovered by concerned citizens, local pediatricians like Hanna-Attisha and independent scientists.