General Information

What is lead poisoning?

What are sources of lead exposure?

What are the symptoms of lead poisoning?

What are the adverse health effects of lead poisoning?

How to reduce or prevent lead poisoning?

Blood lead screening and testing

Lead Exposure Risk Assessment Questionnaire (LERAQ)

What is lead poisoning? 

Lead poisoning or lead toxicity is a condition that is caused by exposure to lead which results in elevated blood lead levels and the accompanying long term damage. Lead is a metal that occurs naturally in the environment and exists all around us. Lead is found in air, soil, water, and even in our homes. Although it has many beneficial industrial uses, it is harmful to humans when ingested or inhaled. There is no safe level of lead in the body. It is particularly harmful to the developing brains and nervous systems of fetuses and young children. This is especially true during the critical development periods of early childhood. Young children are most vulnerable to the effects of lead because they absorb a greater percentage of lead and it can cause the most harm while they are quickly growing and developing.  

Lead is highly toxic and is found in many products in and around the home. You cannot see, taste, or smell lead, so it may be in your home environment without your knowledge. It is generally found in paint, dust, or soil in or around older housing, particularly housing built before 1950.  The federal government banned the use of  lead-based paint in 1978, therefore it could be found in any home built before 1978.  Even though lead-based paint is the most common lead exposure source, there are other sources of lead exposure which could result in lead poisoning.

Blood lead levels are measured as micrograms of lead per deciliter of whole blood (µg/dL). Although there is no scientific evidence on a safe level of lead in the blood, the Centers for Disease Control and Prevention (CDC) uses an action level of 5 µg/dL. The action level, sometimes seen on laboratory reports as a 'reference level',  refers to a blood lead level at which recommended specific interventions should be implemented to reduce the blood lead levels in the body. Once lead enters the blood stream it can also be stored in organs, tissues, bones, and teeth. Most childhood lead programs focus outreach and education on children in the higher risk range of 6 to 72 months of age. However, a level of 5 µg/dL or higher would be considered elevated for any age group.

What are sources of lead exposure?

Although lead is no longer added to household paint or gasoline and cannot exceed set standards in many consumer products, many sources of lead still exist and thus pose a health hazard.

Lead-Based Paint and Lead Contaminated Soil and Dust

The most common risk factor for childhood lead poisoning is still the deteriorating residential lead-based paint which is found in almost all housing units built prior to 1950.  Houses built between 1950 and 1978 are less likely to contain high amounts of lead in the paint, but are still a potential source. Lead-based paint was banned from use in household paint in 1978, which means that houses built before 1978 potentially contain lead-based paint. Another common source of lead is lead contaminated dust and soil. Children are most often poisoned when lead-contaminated dust caused by deteriorating paint gets on their hands or toys and is then transferred to their mouths. Sometimes children may eat paint chips or inhale leaded dust.

According to the Centers for Disease Control and Prevention (CDC), deteriorated lead-based paint and elevated levels of lead contaminated house dust can be found in an estimated 24 million U.S. housing units. More than 4 million of these units are homes to one or more young children.

Lead in Water 

Houses containing lead pipes or pipes soldered or welded together with metals containing lead, may have high lead levels in drinking water. According to the U.S. Environmental Protection Agency (EPA) homes built before 1986 are more likely to contain lead pipes, fixtures, and solder. Lead may enter tap water through corrosion of plumbing. Corrosion is a reaction between the water and the lead pipes or solder. Dissolved oxygen, low pH (acidity) and low mineral content in water are common causes of corrosion.

Take-Home Sources and Hobbies

It is important to note that children can be exposed to lead hazards through “take home” sources. In other words, lead particles brought home on the clothes, shoes, or hands of an adult who works in an occupation that exposes him/her to lead. At work, people are usually exposed by breathing in air that contains lead particles. Families of workers may be exposed to higher levels of lead when workers bring home lead dust on their work clothes and shoes. 

Work that involves industrial paint (which may still contain lead) such as painting or scraping bridges or water towers, cable splicing, construction, mining, radiator repair, recovery of gold and silver, repair and reclamation of lead batteries, smelting, welding, working on firing ranges and oil fields, and manufacturing bullets, ceramic tiles, electrical components, and lead batteries, are some of the occupations where workers may be exposed to lead.

Children may also come in contact with lead and become lead poisoned through household member's hobbies and leisure activities such as making stained glass with lead, pottery with lead glaze, making or reloading bullets and fishing sinkers with lead, and refinishing furniture and painting with lead-based varnishes.

Lead in Toys

Children may be exposed to lead from toys that have been made in other countries and imported into the United States or from antique toys and collectibles passed down through generations. Lead may also be found in older toys made in the United States. The U.S. Consumer Protection Safety Commission (CPSC) is responsible for announcing recalls of toys which contain excessive levels of lead and could result in adverse health effects.

Recalled toys that show signs of wear (chipped or peeling paint) or have cracked or broken parts are of special concern. Children are at the greatest risk from lead exposure and children under 36 months of age are particularly susceptible because of this age group's normal hand-to-mouth behaviors.

A complete list of all the recalled products can be found at the CPSC website. To subscribe to the CPSC's email distribution list to receive bulletins about recalled products, consumers can go HERE. 

Please also refer to National Center for Healthy Housing (NCHH) fact sheets: Toys and Childhood Lead Exposure and Testing for Lead in Consumer Items for Children for additional information on toys and lead hazards. 

Home Health Remedies, Imported Cosmetics, and Pottery

Certain traditional home health remedies contain lead. Greta and Azarcón are used by Hispanic communities to treat upset stomach or indigestion. Pay-loo-ah is used within the Hmong community and given to children as a cure for rash or fever. Certain Asian remedies are also found to contain lead such as Bali Goli, Ghasard, and Kandu. 

Kohl (also known as Kajal or Surma) is used by Middle Eastern and South Asian communities. It is a traditional cosmetic used as an eyeliner, however, it contains high levels of lead. Sindoor powder which if often used a symbol of matrimony in Hinduism may also contain high amounts of lead.

Lead may also leach into food if it is put into improperly glazed pottery or ceramic ware usually made outside the United States (especially bean pots from Mexico or tagines from Morocco). Some vintage or antique plates and dinnerware may also contain lead in the glaze or painted surfaces, so country of origin is not always an indicator of potential lead in a product.

Leaded Mini Blinds

In 1996, the CPSC issued a warning that some imported vinyl (plastic) mini blinds manufactured in China, Taiwan, Mexico, and Indonesia may present a lead poisoning hazard for young children. Lead is used as a fixative in the vinyl. As the vinyl deteriorates when exposed to sunlight and heat, it forms lead dust on the surface of the blinds that children can get on their hands and then in their mouths. New mini blinds should always be in a box labeled "Lead Free." Some homes may still have leaded mini blinds installed prior to 1996. 

What are the symptoms of lead poisoning?

There are likely no noticeable symptoms of lead poisoning in children or adults, unless the lead level is extremely high. This is why obtaining a simple blood lead test is the only true way to know if your child has lead in their system. If there are symptoms, they are likely to be as follows:

Children

• Loss of appetite 
• Vomiting 
• Diarrhea
• Stomach cramps
• Constipation
• Learning problems
• Difficulty in sleeping
• Anemia

Adults 

• Stomach pain
• Fatigue
• Decreased libido
• Headache
• Irritability
• Muscle or joint pain

What are some of the adverse health effects of lead poisoning?

Children

• Learning disabilities 
• Language and behavioral problems 
• Lower I.Q. 
• Attention deficit disorder
• Hearing loss
• Anemia
• Muscle weakness
• Damage to nervous system and kidneys
• Death by lead poisoning is uncommon but can happen

Adults

• Hypertension (High Blood Pressure)
  
• Hearing loss
• Infertility 
• Anemia 
• Peripheral neuropathy (damage to nerves supplying sensation to arms and legs) 
• Damage to nervous system and kidneys

How to prevent or reduce lead poisoning?

The most important way families can prevent or reduce lead poisoning is to know about the sources of lead inside as well as outside their homes and avoid exposure to these sources. 

• If the home is built before 1978, use these tips to avoid lead poisoning from contaminated household dust:
• Ideally, have your home inspected for lead-based paint by a certified lead-based paint risk assessor.
• Do not sweep paint chips and/or dust or vacuum unless it is with a true high efficiency particulate air (HEPA) filter that is rated to remove lead dust particles.
• Clean floors, walls, and window sills often with a wet cloth or mop, using a high phosphate detergent (such as Cascade powdered dish washing detergent).
• Wash your child's hands and face often, specially before eating.
• Feed your child healthy meals three times a day and two or three healthy snacks. Look for items that are rich in calcium and iron.
• Maintain regular visits to your health care provider even when your child is not sick.
• Make sure children play in safe areas with no exposed dirt.
• Wash toys daily.
• Have your child tested for lead. This can be done with a small fingerstick and must be done at age 12 months and again at 24 months.
• Do not burn painted boards, newspapers, colored paper or magazines in a wood burning stove or fireplace.

• If you think you have lead in your water:
     
  • Do not use hot tap water for cooking or preparing formula, since it is likely to contain higher levels of lead. Use cold water for cooking.
  • Let the cold water run 2-3 minutes before using for the first time each day. The more time water has been sitting in your home's pipes, the more lead it may contain.
  • You can purchase filters either as pitchers or add-ons to your faucet that can remove lead. Be sure they have an NSF rating that says they remove lead.
    • Click here for more information on NSF Certified Product Listings for Lead Reduction.
      
  • If you are using filters to remove lead, be sure you change them out when recommended by the manufacturer.
  • Contact the Oklahoma Department of Environmental Quality at 405-702-1000 if you want to have your water tested for lead.

• If your work or hobby involves working with lead, then follow some simple guidelines to protect yourself and reduce the chances of bringing lead contamination home:
    
  • Wash your hands and face before eating, drinking, or smoking. Take breaks away from lead dust and fumes.
  • Wear protective equipment and clothing over your clothes whenever you work with lead.
  • Wear a clean, properly fitted respirator in all areas exposed to lead dust or fumes.
  • Obtain a Material Safety Data Sheet (MSDS) from your supervisor or employer. It will identify materials on the work site that contain lead.
  • Use work practices that reduce your exposure. For example, use cold damp scraping methods to remove paint. Avoid heat guns and power sprays to remove paint.
  • Never use high pressure water or compressed air to clean up if you work with lead, this can spread lead dust or fumes around.
  • Avoid sweeping work site dust. If vacuuming, use a vacuum with a true HEPA filter, preferably one that is rated to remove lead dust particles.
  • Use a damp mop and clean using a high phosphate detergent.
  • Shower and shampoo thoroughly after work (lead dust may stick to skin and hair).
  • Change shoes and clothes before you go home, if possible.
  • Launder your work clothes at work if laundry services are provided by your employer.
  • If clothing must be laundered at home, launder them separately from your family’s clothes and run an empty washer in between laundry to avoid cross contamination.
  • Cut fingernails short and clean them carefully.

• If you suspect that your child has been exposed to a toy containing lead:

• • Refer to the CPSC website for pictures or product identification.
  • Any recalled toy should be removed and returned to the manufacturer according to the instructions that are provided on the CPSC web site. Any toys that show signs of wear (chipped or peeling paint) or have cracked or broken parts are of special concern. Suspicious toys should be removed from the child's access immediately. A free e-mail subscription to the CPSC recall list is also available on their web site.
  • Consult with the child's primary health care provider for further assessment for blood lead testing. Remember, your child must have a blood lead test at 12 months and 24 months, but can be assessed with a questionnaire at other times to determine their need for further testing.  An example questionnaire is the Lead Exposure Risk Assessment Questionnaire (LERAQ).  

• Avoid using home remedies (such as Greta, Azarcón, Pay-loo-ah) and cosmetics (such as Kohl, Surma, Sindoor)  that contain lead.
• Avoid using imported pottery (especially from Mexico) unless you are certain that it does not contain lead.
• If you think your home has imported vinyl (plastic) mini blinds, replace them with new mini blinds that state on the packaging that they are "lead free."

Blood lead screening and testing

• Most children with elevated blood lead levels (EBLLs) have no obvious signs and symptoms. A blood test is the only sure way to know if your child has lead poisoning. Most test results are rounded up or down to the nearest whole number.  A result of 4.5 µg/dL may be reported as 5 µg/dL, whereas a result of 4.4 µg/dL may be reported as 4 µg/dL.
• The Oklahoma Childhood Lead Poisoning Prevention Program (OCLPPP) and state statutes advise that health care providers shall obtain a blood lead test on all children at 12 and 24 months of age. Any child who has not reached their 6th birthday and has never had a blood lead test is also required to have one. During other ages, children 6-72 months of age, should be assessed with the LERAQ to determine the need for additional blood lead testing.  If you (parent/guardian) answers “yes” to any of the questions, your child shall receive a blood lead test. Contact your health care provider to schedule an appointment for a blood lead test for your child, if your child is turning 12 months or 24 months of age.
• The first test can be a screening test using blood taken from the finger. This is called a capillary test. If the result of the capillary test is 5 µg/dL or greater, then the child shall receive a confirmatory blood test.  Normally, this is a venous test (blood taken from the arm). However, if the fingerstick blood lead level was in the range of 5-9 µg/dL, a second capillary (fingerstick) test may be used to confirm the results .
• Five μg/dL of lead in children’s blood is considered to be the action level for intervention by the CDC. Recommendations from the CDC say that venous blood specimens are preferred for blood lead analysis. An elevated blood lead level obtained through a fingerstick must be confirmed.

• If your child's blood lead test is confirmed to be elevated (5 µg/dL or greater) then you will be asked to have your child tested approximately every 3 months to ensure that the blood lead level is going down.  Follow-up testing will continue until your child receives two blood lead tests that are lower than 5 µg/dL, and these tests are at least 3 months apart. The higher the blood lead level, the more often follow-up testing may be required.
• For a child with an elevated venous blood lead level of 20 µg/dL or higher, the OCLPPP will offer to conduct an environmental investigation of your home to help you determine the source of lead exposure for your child.  These investigations are of no-cost to you and may be offered for lower levels (between 15-19 µg/dL, if your child's blood lead levels show a pattern of persistent elevation). Please refer to the Management Guidelines to see how the OCLPPP currently recommends follow-up testing for children 6-72 months of age.
• All Medicaid-enrolled children, just like children with private health insurance, must be tested for lead exposure at 12 and 24 months of age as part of the Early Periodic Screening, Diagnosis and Treatment (EPSDT) services. Parents should remind their child's Medicaid provider that a lead test is a required part of the EPSDT service to their child. For additional information about EPSDT services, visit the Oklahoma Health Care Authority - EPSDT page.

Lead Exposure Risk Assessment Questionnaire (LERAQ) - English

Lead Exposure Risk Assessment Questionnaire (LERAQ) - Spanish