W.Pa. doctors call for universal testing of children's lead levels
Dr. Scott Tyson wants every toddler who passes through his Pediatrics South practice to have a blood test for lead.
He first brings up the test with parents at a child's 9-month appointment, giving them a slip to take to a lab where a technician will draw blood. He asks parents about the test three months later and another three months after that. He continues to ask until they get the test.
About one-tenth of 1 percent of the children in his practice, with offices in Mt. Lebanon, Robinson and Peters, has an elevated level of lead. But Tyson persists; the risk, however slight, is too high. Testing, Tyson said, is the best way to prevent and combat the debilitating effects of lead poisoning later in a child's life.
“It can be so devastating, and there are absolutely no signs of it. With early lead exposure, you see a healthy, healthy kid who just develops problems,” Tyson said. “Testing is one of those things that should be a no-brainer.”
The water crisis in Flint, Mich., has shoved concerns about lead back into the spotlight, and with it have come calls for universal testing of lead levels in children.
Maryland announced late last year it would adopt universal testing for 1- and 2-year-olds. Massachusetts and Rhode Island require universal testing.
Pennsylvania Gov. Tom Wolf supports universal testing and has been studying proposed legislation to implement it, said his spokesman, Jeff Sheridan. The state Department of Health wants universal testing of 1- and 2-year-olds, said Dr. Loren Robinson, the state Department of Health's deputy secretary for health promotion and disease prevention. The Allegheny County Health Department is examining what the county could do if the state does not act.
“After what happened in Flint, I think people are scared and parents are scared. They want to know that their children are safe,” Robinson said. “We can never really say what our true rates of elevated blood levels are if we don't test every child.”
About 25 percent of 1- and 2-year-olds were tested for lead, according to the state Department of Health's 2014 Childhood Lead Surveillance Annual Report, the most recent report available. But less than 14 percent of children in the state were tested for lead by their 7th birthdays, nearly 3 percent less than 2013, the report stated.
About 15 percent of children under 7 in Allegheny County and 39 percent of children in Pittsburgh were tested. Eleven percent of children in Westmoreland County were tested for lead.
CDC begs to differ
The Centers for Disease Control and Prevention and the American Academy of Pediatrics, however, do not advocate universal testing. The CDC recommends local health officials determine which children are at risk for high blood lead levels using local data and test those children, Bernadette Burden, an agency spokeswoman, wrote in a statement. If there is no data, then the CDC recommends universal blood lead testing of 1- and 2-year-olds, focusing on children in older houses and poverty.
Universal testing could overwhelm the health care system, said Dr. Jennifer Lowry, chief of toxicology at Children's Mercy Hospital in Kansas City, Mo., and chair to the Council on Environmental Health for the American Academy of Pediatrics. A majority of children tested will test negative, which is good, but it could be seen as a waste of resources. Screening, when done effectively, can identify the at-risk children who should be tested.
“Every child should be screened, and if you have at least one ‘yes' (answer to a) question, you should be tested,” Lowry said, who worried that improper screening has dropped the number of children tested across the country to dangerously low levels. “We have no idea how many children are poisoned with lead.”
Pediatricians should ask parents about the age of their homes, the age of other places — grandma's house, day care — where their children spent time, to see if there could be lead paint, which was banned in 1978. They should ask if children put non-food items in their mouths, like dirt or jewelry that could have lead. They should ask about whether the parents work at some jobs in battery and automotive plants, which can put children at risk. Hobbies such as fishing and pottery can also expose children to lead, Lowry said.
Some pediatricians use a finger-prick blood test to screen for lead, Lowry said. The test can show the prevalence of lead in a child's body but can also give a drastically high number if the child has lead on his or her hand, Lowry said.
Where greatest risk lies
Statewide, according to the Department of Health report, about 9 percent of children had levels of 5 micrograms per deciliter or above, the amount considered elevated by the CDC, which also states that there is no safe level of lead in children. About 7 percent of children in Allegheny and Westmoreland counties had lead levels at or above the CDC threshold and 8 percent of children in Pittsburgh hit or exceeded that mark.
While the number of children with elevated levels of lead in their blood has fallen by about 45 percent in the eight years covered by the Department of Health's report, the drop in the number of children tested — up from the 131,000 tested in 2007 but down from its peak in 2011 of nearly 151,000 to about 140,000 in 2014 — has health officials worried.
“That scares me,” Tyson said of the drop in testing numbers. “It tends to be the urban poor and the rural areas that aren't getting tested, and I think the likelihood is you're going to find the higher risk there.”
The 2014 lead surveillance report showed that 14 percent of children in urban areas and 11.5 percent of children in rural areas were tested. About 80 percent of the children with elevated lead levels lived in urban areas.
Lead paint in homes presents the greatest risk to children. As old paint flakes or crumbles, children can ingest it or inhale dust. Lead was banned in paint in 1978. About 70 percent of homes in Pennsylvania were built before 1978, ranking the state fifth in the country. Lead can also be present in the ground and the dirt that children sometimes put in their mouths. Lead poisoning from drinking water, which occurs when lead leaches from pipes and solder, while a concern, does not contribute as much to levels in children.
Tyson said for rural areas and among the urban poor, access to remediation services and health care can be scant.
“It's kind of a no-brainer for me because we have so many poor patients,” said Dr. Hans Kersten, an attending physician at St. Christopher's Hospital for Children in north Philadelphia and a professor of pediatrics at Drexel University, adding he can understand why a doctor in a more affluent part of town might now screen all children because the risk is lower. “But we really don't know unless they screen.”
Many going unscreened
Lead tests are covered by health insurance plans offered under the Affordable Care Act and on the state's exchange. Most private insurance plans cover tests as well.
Medicaid and the state's Children's Health Insurance Program cover and recommend lead tests for all children, said Mike Race, a vice president with the Pennsylvania Partnerships for Children. About 75 percent of children on Medicaid and 50 percent of children enrolled in CHIP were tested for lead, according to the 2013 statistics.
That's not good enough, Race said.
“We don't know how many kids in the state might not be getting a lead screening, but we do know that among the kids in public health insurance programs, there is a significant portion not being screened,” Race said.
Dr. Karen Hacker, head of the Allegheny County Health Department, said there could be many reasons why children aren't screened for lead. Some pediatricians might decide not to screen based on questions they ask. Some parents might decide not to screen because they don't think there is a risk and they don't want to subject their children to a blood draw, which can be traumatic.
Jennifer and Peter Jezowicz didn't hesitate to have their children tested for lead. They had their Ingram house tested and inspected before they moved in, but when Dr. Tyson recommended a screening, they followed through. Neither Kamryn, 2, nor Kinsley, 1, had elevated levels in their blood.
And the peace of mind was worth the trauma.
“They cried,” Jennifer Jezowicz said. “You get the beet-red face. You get the screaming. You get the tears, but it's an infant, and 10 minutes later they are fine. You have a bottle ready. You have a snack.”
Aaron Aupperlee is a Tribune-Review staff writer. Reach him at 412-320-7986 or firstname.lastname@example.org.