Very few children here tested for lead poisoning

Lead seems to be lurking everywhere these days.

From high-end toys to dollar-store jewelry and vinyl lunchboxes, the recalls keep coming. Laboratory tests reported Thursday by The Seattle Times showed some local stores are selling children's trinkets with dangerous levels of the toxic metal.

But does lead poisoning pose a significant hazard to kids in Washington?

It's hard to tell, because the state has one of the lowest rates of lead testing in the nation.

Health Department officials say that's because the problem is rare here. But other experts argue Washington should be testing more children. They cite a growing body of evidence that suggests federal standards aren't protective and even minuscule amounts of lead can impair brain power.

The state also is facing the threat of a lawsuit for failing to screen children in the Medicaid health-care program for low-income families.

"There's no data saying lead is a problem in Washington, but that's because we've never really looked," said Seattle toxicologist Steven Gilbert, who directs the independent Institute for Neurotoxicity and Neurological Disorders.

According to data from the U.S. Centers for Disease Control and Prevention, less than 1 percent of Washington children 6 and under were tested for lead last year. Only Nevada and Nebraska tested a smaller fraction. Nationally, about 14 percent of children get lead tests.

Critic says policy illegal

When it comes to kids covered by Medicaid, Washington's track record is even worse: Half a percent of eligible children were tested last year.

That violates federal law, which requires screening for all children in the program, said Rick Eichstaedt, an attorney at the Center for Justice, a public-interest law firm in Spokane.

This summer, the center asked the state to promote lead testing for more children, but the Department of Social and Health Services — which manages the Medicaid program — said it wasn't justified. Idaho was forced to expand its testing program after a lawsuit, and that's a possibility in Washington, Eichstaedt said.

"The law is pretty clear," he said. "Low-income children are particularly susceptible to lead poisoning."

Washington was chided for a lackluster approach to lead testing in a 1999 Government Accountability Office report.

Historically, the state hasn't been more aggressive about lead testing because the prevalence of lead poisoning seems to be low, said Glen Patrick, environmental-epidemiology program manager for the Washington Department of Health.

Over the past several years, only about 1 percent of all children tested in Washington exceeded the federal level of concern: 10 micrograms of lead per deciliter of blood.

But the program may not be giving a clear picture, Patrick said. "The bottom line is, given the small amount of testing here ... we don't know."

In 2006, Washington reported 50 children who met the federal definition of lead poisoning. Another 250 had slightly elevated levels, but fell under the cutoff of 10 micrograms.

Testing has revealed some hot spots, including Central Washington, where up to 4 percent of Hispanic children had high blood lead.

In other states, between 0.25 and 4.5 percent of children screened are diagnosed with lead poisoning.

The state doesn't conduct lead screening. Anyone can ask a doctor for a test. The cost is covered by Medicaid and most insurance. But critics say the state has done little to encourage people to seek tests, or to identify children at risk. Currently, most tests are instigated by doctors who suspect lead poisoning.

Nicole Thomsen, who investigates lead-poisoning cases for Public Health — Seattle & King County, says some doctors are reluctant to order tests for low-income patients because Medicaid pays less than $20 for the procedure. Private labs and physicians charge uninsured people $80 to $250 for the test.

Dr. William Robertson, emeritus director of the Washington Poison Center, believes the threat of lead poisoning, particularly from toys and jewelry, has been overblown.

In the past four years, one child in the U.S. died from lead poisoning after swallowing a lead charm and one was severely injured. No specific injuries or deaths have been linked to lead-tainted toys, he pointed out.

In the 1970s, nearly everyone in the country had elevated levels of blood lead, thanks to leaded gasoline. Before that, lead paint was common — as were life-threatening cases of lead poisoning, Robertson said.

Doctors sometimes drilled holes in victims' heads to relieve brain swelling. Many died of infections and pneumonia because their immune systems were weakened.

Since lead was banned in gasoline and paint, lead poisoning has plummeted. And the problem has always been less common on the West Coast because houses here are newer and less likely to have lead paint, Robertson said.

Lower threshold urged

While the pall of lead pollution has lifted, evidence is mounting that as little as 2 to 3 micrograms per deciliter of blood can shave points off children's IQ scores, said Dr. Bruce Lanphear, a leading lead researcher and director of the Cincinnati Children's Environmental Health Center.

Multiple studies show incremental damage to the brain and nervous system is highest as children's blood lead levels rise from 1 to 9 micrograms — the range now considered "normal."

"By the time you get to 10, the damage is done," said Gilbert, the Seattle toxicologist, who has urged the federal government to lower its threshold of concern.

Exposure to lead has also been implicated in attention-deficit hyperactivity disorder and other behavioral problems in children, and heart-attack, stroke and kidney problems in adults, Lanphear said. And because the body confuses lead with calcium, the toxic metal can linger in bone for years, leaching out during pregnancy or times of stress.

Blood tests are the only way to tell whether a child is suffering from lead poisoning, said Ngozi Oleru, director of environmental health for Public Health — Seattle & King County, which is trying to boost screening of local children.

There's no treatment, unless levels are life-threatening. Local health-department staff helps families identify and eliminate sources of lead.

Lead paint biggest threat

Lead paint is still the biggest source in Washington. But small exposures can add up, too, Gilbert said. "It's a little bit from the jewelry, a little bit in the dirt, a little bit from paint, and suddenly you've got significant exposure," he said.

Folks who lived through the onslaught of lead pollution from gasoline and paint may argue that they escaped harm, so the effect of today's lower exposures must be minimal, he added. "But I always wonder: If I hadn't been exposed back then, maybe I would be full professor now."

State legislators this year surprised the health department by providing an extra $824,000 to bolster lead testing and education programs.

At Sea Mar Community Health Centers' clinic in Seattle's South Park neighborhood, Dr. Cornelius Van Niel has launched his own study. He plans to screen several hundred youngsters to see if lead poisoning is more prevalent among his mostly low-income, Hispanic patients.

"Hopefully, that won't be the case," he said. "But I'm concerned."

Sandi Doughton: 206-464-2491 or sdoughton@seattletimes.com

Information in the article, originally published December 21, 2007 was corrected on December 23, 2007. A photo caption should have said that up to 9 micrograms of lead per deciliter of blood is considered "normal." Due to an editing error, an incorrect amount was given. The story was also corrected on January 1, 2008. A previous version of the story mistakenly reported that as little as 2 to 3 milligrams per deciliter of blood can diminish children's IQs. Actually, impacts on IQ have been measured at lead levels of 2 to 3 micrograms per deciliter of blood, a much smaller concentration.