The number of Missouri children facing risks from lead poisoning has risen sharply because a federal agency has lowered the threshold, saying youngsters can be harmed by ingesting even tiny amounts of lead.

Until recently, children were thought to be harmed if the level of lead in their bodies was as low as 10 micrograms for each deciliter of blood. About two weeks ago, the Centers for Disease Control and Prevention (CDC) reduced the threshold to five micrograms.

The CDC adopted the rule because studies showed that many children who ingest large amounts of lead can suffer from physical and behavior problems. Though dust is a common problem, the lead can also come from imported toys, jewelry, pottery and other items containing lead-based paint.

The new rule means the number of Missouri children considered to have elevated blood lead levels has jumped 586 percent — to 4,887 from 712.  The new threshold also means the number of St. Louis children testing positive has risen to 1,436 from 320. That difference represents a 348 percent increase. Even so, city officials say, they foresee no problems in accommodating these new cases.

"The city's primary prevention strategies of education and remediation of lead hazards have helped to reduce childhood lead exposure significantly," says Pamela Walker, director of the St. Louis Health Department. 

In addition, she says the city has turned to an innovative approach of inspection and remediation of homes of pregnant mothers before their children are born. The positive results of that approach were the subject of a study in the March edition of the Journal of Obstetrics & Gynecology. 

St. Louis tops the list in the number of Missouri children testing positive for lead, followed by St. Louis County, Kansas City, Jasper County and Jackson County.

Cities in some other states have worried about funding because Congress has reduced the CDC's anti-lead budget to $2 million from $29 million. But Walker says the city got only about 13 percent of its lead money from that source and gets another 70 percent from a Department of Housing and Urban Development grant. She adds the city Board of Aldermen is considering legislation for additional funding to offset the loss of federal dollars.

Walker says the city already has been focused for years on reaching families whose children have blood lead levels of 5 micrograms or higher and that the city will continue reaching out and encouraging vulnerable families to have their homes inspected for lead hazards. City officials note that the problem is more prevalent in some ZIP codes because of more children, older housing and other adverse socioeconomic conditions.

Among those pleased by the new lead threshold is Todd S. Hageman of the Simon Law Firm. He won a $1.2 million jury verdict about a decade ago on behalf of a city child who suffered lead poisoning. The judgment remains the largest ever obtained in Missouri.

"There is no known safe level of lead in the body," Hageman says, "so the lower the threshold, the earlier the intervention and hopefully the number of exposed kids will be lower." He expects the new rule to lead to "heightened awareness, heightened education and intervention.  These will be good for individuals and public health."

County may see an increase

St. Louis County health officials didn't comment on the CDC's new rule and did not provide updated data on the number of children affected by it. But if the new threshold level had been in effect last year, the number of lead cases in the county would have risen to 573 from 59, a jump of 871 percent. It's likely that the numbers in the county would be somewhat lower, however, because of prevention and remediation work done in the past year.

One of the big targets of lead prevention has been property owned by the St. Louis school system. Richelle S. Clark, manager of the district's office of health services, notes that some proactive measures are in place: Preschool students must now have annual blood lead tests before enrolling.

"When the child is found to have an elevated lead level, the school nurse works with the family and the health-care provider to ensure appropriate follow-up treatment is completed," she says.

The district has contracted with Environmental Consultants of Collinsville to address the district's lead issues. Jeffrey M. Faust, the company's principal, says the district has focused on reducing lead dust hazards in rooms where children spend most of their day. About half of the kindergartner and pre-kindergartner classrooms have been subjected to this approach.

"Obviously, our efforts are just part of an ongoing plan to reduce lead exposure in our schools," he says, adding that funding will affect how much is done to address the problem.

Some  supporters of stronger measures say more attention should be paid to lead dust. Carol Prombo, a lecturer in earth and planetary science at Washington University, offers a variation of a comment by former President Bill Clinton as a way to help the public understand what she says is the most harmful source of poisoning.

"It's the dust, stupid," she says, half humorously. "Kids are poisoned as a result of "ambient household dust in homes with old lead-laden windows and in places with high levels of lead in the soil," she says.

That tells her that parents could do much to reduce the exposure if the parents had a better understanding of the problem.

Many people assume children are poisoned only from eating paint chips and playing with lead-tainted toys imported from countries such as China, she says.
"If people understood that children get lead poisoned from the ambient household dust in their homes, lead exposure would drop like a rock."