Dr. Debra Bogen: Applesauce recall shows importance of testing all children for lead poisoning

For more than 50 years, we have known that lead poisoning can have devastating effects on children’s developing brains. Lead is a neurotoxin, and there is no safe blood lead level for children.

According to the Centers for Disease Control and Prevention (CDC), lead exposure in children can result in damage to the brain and nervous system, slowed growth and development, learning and behavior problems, and hearing and speech problems. This can result in lower IQ, decreased ability to pay attention and poorer school performance.

The only way to definitively know if a child is being exposed is to test for lead in blood. Although lead paint remains the No. 1 source of lead contamination for children, sources vary widely, from older homes, water pipes and antique toys to some imported toys, jewelry and consumables. In 2023 alone, there were eight lead-related product recalls from the U.S. Consumer Product Safety Commission.

It is vital that children be screened for lead exposure during their late infancy or early toddler years when they are at highest risk. During these times, children crawl and explore things by putting them in their mouths. This is normal, healthy behavior and development, but it increases the risk of ingesting lead if it is present. Also, infancy and toddlerhood are times of very rapid brain growth and development. Eighty percent of brain growth happens by age 3 and 90% by age 5.

There is no better recent example of the need for routine lead testing than the discovery of lead from tainted cinnamon in children’s applesauce pouches last year. Two North Carolina children were tested for lead as part of their routine medical care, and when their lead levels were elevated, the North Carolina public health system investigated. An initial home inspection found no lead. Appropriately, the children’s levels were monitored, and they continued to increase. The strong investigative work by public health professionals led to the discovery of lead in specific brands of cinnamon applesauce pouches, a nationwide food recall and further testing of imported cinnamon. Sadly, hundreds of American families are learning that their children were exposed to lead from the cinnamon applesauce pouches. However, many more were protected because of the routine lead screening in North Carolina and the ensuing public health response.

As a pediatrician, I identified many children with elevated lead levels due to routine screening, and rarely due to symptoms. If we wait to test for lead until a child shows symptoms of lead poisoning, we have missed the chance to prevent damage. To protect children from this preventable health problem, we need to continue to remove lead from their environments and screen them early to prevent the most severe brain effects.

In Pennsylvania, 55.4% of children born in the state in 2018 were tested for blood lead before their second birthday. Of those tested, 1.74% (1,300 children) had elevated blood lead levels. Among Black and Hispanic children, 2.6% had elevated blood lead levels. Clearly, we are missing children with elevated lead levels because of our current low screening rate.

Thankfully, we can do something. Policymakers have introduced legislation in both the Pennsylvania House and Senate that would increase lead testing for children. I look forward to working in partnership with the Legislature to advance this critical public health legislation to protect our children and their developing brains. Parents, you can talk with your child’s health care provider about getting your child tested for lead and use the resources available to keep them safe.

Reducing lead exposure is possible. It starts with identifying the source of the lead, and then giving exposure-specific recommendations.

The Pennsylvania Department of Health, the Lead-Free Promise Project, and the CDC have information on how to reduce lead exposure. Because even low levels of lead exposure can impact development — children with elevated lead levels should have their development closely monitored by their health care provider or the Early Intervention Program (800-692-7288).