Get the Lead Out! Childhood Lead Poisoning in NH What You Need To Know Gail Coppins Gettens, MS Health Promotion Advisor Healthy Homes and Lead Poisoning Prevention Program
Funded by Center for Disease Control 28 Programs within the United Stated
In NH, 800-1000 new child lead poisonings each year, every year. 2x s higher the national average.
Use of LeadCare II BLL Testing and Reporting Requirements.
NH s New Legislation - SB135 July 2015 Childhood Lead Poisoning and Screening Law Impact On All Pediatric Health Care Providers
What is Lead? What is its source? How is it used?
Decline of Roman Empire - lead in aqueduct systems Documented in Benjamin Franklin s letters - 1786 Beethoven's Hearing Loss - lead as sweetener in wine 1892 Australia Epidemic of childhood lead poisoning lead paint
1909 - France and Austria banned white lead interior paint 1922 Tunisia and Greece followed the ban 1926 - Great Britain and Sweden banned interior lead paint 1927 Poland banned all lead based paint. 1931 Spain and Yugosalvia
1914 United States first reported child death from lead poisoning 1922 League of Nations banned lead in paint US declines adopt 1940 s US research demonstrates - if recovered from acute toxicity - significant deficits. 1970 s US research demonstrates cognitive and behavior deficits with no clinical signs of toxicity. 1978 Federal legislation ban its use in residential paint.
Don t see deficits and impact until older No Brain-Blood Developing Brain Sweet Tasting Trace Amounts Oral Stage No Immediate Symptoms Crawl on Floors and Pull to Standing - Surfaces Where Lead Dust Collects Perfect Pediatric Poison Potent Neuro-Toxicant
2012 10 micrograms/dl 5 micrograms/dl
2012 No safe level of lead New reference level 5 mcg/dl Exposed to lead Need case management.
RSA 130.A Current Rules in NH Elevated Blood Lead Level - 5 mcg/dl education Elevated Blood Lead Level 10 mg/dl Public Health Nurse visits and case management Exeter area Robert Lawson, RN Lead Inspector visits to identify lead hazards both use of XRF and water tests If lead hazards found in rental unit under order and landlord required by law to do abatement.
How Much Lead Does It Take To Poison A Child? Demonstration Lead s exposures negative impact on a child s developing brain is irreversible. There is no cure. There is no treatment.
What Is Lead s Negative Impact On A Child s Brain Development? mylen
What Is Lead s Negative Impact On A Child s Brain Development? Reduces myelination of axons Reduces size and number of neurons Causes crossed signals in neurotransmitters Spontaneous signals enhanced and stimulated signals inhibited. Reduces efficacy of neurotransmitter Dopamine frontal lobe/executive function area of brain is dopamine driven
What does Gray Matter Loss in a Child s Brain Look Like? Brain Scan of EBLL of 13 mcg/dl
Source: CDCP Dr. MJ Brown 2014
Even a Little Lead is Unambiguously Bad Study after study 60 years of research shows that lead has unambiguous and long-lasting effects on intelligence, behavior, and health The research established causality: Lead causes these bad outcomes
Even a Little Lead is Unambiguously Bad Early childhood lead exposure appears to have large negative consequences on behavior. Increasing impulsivity and aggression, even moderate exposure can have substantial adverse effects of behavior. These effect persist, from childhood through young adulthood
Lead s NeuroBehavioral Signature
Lead Exposure s Negative Impact On Specific Abilities Attention inattentive, impulsive, Hyperactive/ADD, distractibility, poor organization, lack of persistence in completing tasks Executive Function - deficits in areas of strategic planning, control of impulses, flexibility of thought, self-monitoring of one s own behaviors and emotions Visual/Spatial - poor memory and organization abilities, reasoning with visually presented - non-verbal problems. Presents as deficits in reading and math
Lead Exposure s Negative Impact On Specific Abilities Behavior Challenges - impulsivity, emotional regulation, anti-social behaviors, oppositional, aggression, destructive behaviors. Speech and Language - delays and deficits. Language processing deficits, hearing deficits Fine and Gross Motor - Poor balance, poor coordination, lack of bilateral coordination, clumsiness and unsteadiness, higher rate of injury.
Lead Exposure s Negative Impact On Specific Abilities Lower IQ. Lower or failing test scores Poor school performance and achievement Behavior problems
Long Term Consequences of Lead Exposure Societal Cost of Lead Risky Behaviors Teen Pregnancy Substance Abuse Juvenile Delinquency Child Abuse and Neglect Crime
2014 REPORT Economic Burden of Environmentally Attributed Illness In Children in NH
How Are Children Being Poisoned? 60% of New Hampshire s housing stock was built before lead in residential was banned.
How Are Children Being Poisoned? Friction Surfaces: window and door jams, floors and stair treads Rental Properties that are not well maintained Lead contaminated soil Lead passed from mother to fetus. DIY (Do-It-Yourself) renovations Contractors not following lead-safe work practices 1 in 3 children poisoned during renovations
1 in 3 children are poisoned during a renovation
2010 EPA RRP Law Renovate, Repair, Paint
1 in 3 children are poisoned during a renovation
NH Poisoning and Testing Statistics Serious Need for Improvement NH Data from 2014
In NH, 800-1000 new child lead poisonings each year, every year. 2x s higher the national average.
NH Children in Public Schools School Year 2014 37% of children in public schools who have been tested, have had an EBLL greater than 5 mcg/dl at some point in their lives. 15% of five year olds entering Kindergarten who have been tested, have had an EBLL greater than 5 mcg/d at some point in their lives.
1 & 2 Year Olds Testing Rates 2014 19,509 Children should have been tested Universal Communities, WIC, Medicaid & Head Start 1 year olds Number that Should Be Screened* Number Actually Screened 9,599 7,132 26% Not Tested 2 year olds Number that Should Be Screened* Number Actually Screened 3,657 69% Not Tested 9,910
How To Test A Child s BLL? Simple, in-office, point-of-care finger stick - LeadCare II
Leadcare II Analyzers Developed by Center for Disease Control full endorsed CDC on-line training capillary sample collection for BLL testing Direct reading capillary instrument Magellan Diagnostics Competency Certificate Wash Child s Hands alcohol swab does not remove lead
NH s New Legislation July 2015 SB 135 Childhood Lead Poisoning and Screening Law Notify Parents of Children EBLL 5 9 mcg/dl. Families protected from eviction if child has EBLL Notify Property Owners of Child with EBBL 5 9 mcg/dl. Established target testing rate of 85% - January 2017 - Test all 1 year olds and all 2 year olds or change rules, and move to compliance enforcement. Created Legislatively Appointed Commission on Childhood Lead Poisoning Screening and Prevention
Ralph Spezio ~ Superintendent of Schools ~ Rochester, NY 41%
Insure Children Are Tested Action Steps: Educate Pediatric Health Providers - LeadCare II Results Documented on Health Forms for child care and public schools. Understand Lead s NeuroBehavioral Signature Need for Developmental Screening
Action Steps For Outreach Educate Teachers, Parents, and Community Test Homes, School Buildings, and Child Care Centers Report Unsafe Work Practices - Call Local Health Officer or Healthy Homes LPPP Recommend Policy Change - call or email Senator Dan Feltes and Bill Storo, MD, President of NH Pediatrics Society, Pediatrician at DH Clinic Concord
Questions?