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Mass. Requiring Lead Screening For School Entry

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Responding to mounting evidence that children who have been exposed to lead are at higher risk of developing learning disabilities, Massachussetts has become the. first state to require entering kindergartners to show that they have been tested for lead poisoning.0

A state regulation, which went into effect
last spring and first applied to the class entering kindergarten this month, requires, parents to submit medical records to school officials to prove that their children's blood

The program, the most comprehensive lead-screening effort in the country, follows extensive research showing that young L) children can be adversely affected by even very low levels of lead, including amounts well below those normally associated with lead poisoning.0

According to these findings, children who are exposed to lead--typically from lead-based paint--may have impaired nervous system functioning, delayed cognitive development, and lower IQ scores. "Lead poisoning is totally preventable,"# said Herbert Needleman, a professor of psychiatry and pediatrics at the University of Pittsburgh's medical school and a leading# researcher on the subject.

"What we need to do is to get it out of housing," he said. "But until we do, we have" to pick it up in the children."

According to the Massachusetts regulation, public and private physicians will be required to screen all children for lead poisoning beginning when they are between 9 months and 1 year old, and then test again at each annual physical until the child reaches age 4.

Children who are thought to be at higher risk of lead poisoning--for instance, those who live in houses with lead-based paint or have parents who work in lead-related industries--are required to be tested more frequently.

Observers say that the Massachusetts program is unique because it affects all of the state's children.

A recent study completed by researchers in the Washington State health department found that while 30 other states and the District of Columbia sponsored limited screening programs, none were as comprehensive as the effort in Massachusetts. Most screening programs, experts say, concentrate on poor children or those thought to be at high risk for lead poisoning. These protocols follow recommendations made by the U.S. Centers for Disease Control and the American Academy of Pediatrics, neither of which recommends universal screening. #

But emerging evidence suggests that many middle- and upper-income children are also at risk for lead poisoning, especially if they move into homes with lead-based paint.

The Massachusetts program is Lalso unusual because of the level of services provided to children who are found to have more than 25 micrograms of lead per liter of blood,the level at which the CDC recommends remedial action.0

State protocols require state or local inspectors to examine such youngsters' homes for lead-based paint. State law requires the building owner to remove any lead-based paint that is chipping or flaking, or is "bitable" below five feet.

Case managers, meanwhile, ensure that the children receive the necessary medical care. In many cases, Massachusetts health officials say, a child's blood-lead level will drop after the paint is removed from the home.0

Nationally, the U.S. Health and Human Services Department estimates that more than 200,000 children between the ages of 6 months and 5 years, or about 1.5 percent of all children in this age range, have blood-lead levels at or above the level at which action is recommended.

Over the last several years, how ever, more and more research has suggested that children are adversely affected by lead levels below 25 micrograms per liter of blood. In response, the CDC is widely expected to lower the recommended action level to 15 micrograms by the end of the year. According to the CDC, more than one in six preschool-age children, or about 3 million nation wide, have blood-lead levels that exceed this amount.

Thomas Matte, a medical epidemiologist with the lead-poisoning- prevention branch at the CDC, noted that children are not technically considered to be lead poisoned unless they have blood-lead levels that exceed 50 micrograms. Below that level, he said, the effects of lead are more subtle. "There doesn't seem to be a bright line that separates safe from unsafe levels," he said.

Dr. Matte said he felt lowering the action level to much below 15 micrograms would be counterproductive,since not every child with that level would have learning disabilities.What is most important, he said, is taking preventive action to avert future problems.

"We need to start abating [leadpaint] without using the child as the 'canary' to make that decision," he said.

Observers say there is good reason for Massachusetts' long history of ad dressing the hazards posed by lead.

"No other state in the Union has as many old, industrialized cities," explained Roy Petre, senior planner in the state health department's childhood lead-poisoning-prevention program. "We're still faced with a housing stock that is over 60 per cent leaded, or 1.2 million units."0

The impetus for the new Massachusetts regulation was a law adopt ed by the legislature in 1987, which required the health department to develop a protocol for testing children for lead exposure. Many provisions of the law were included in a report on lead that was completed by a special legislative panel in 1986.

But it was the health department, said Mr. Petre, that decided to add the requirement for entering kindergarten students. Many students, he said, lack basic medical care and might not ever see a doctor if it were not required for school entrance. "It was an important kind of safety net to make sure that no child would be lead poisoned upon entry to kindergarten and never identified," Mr. Petre said.

"It isn't the intention of the regulation to prevent any child from entering kindergarten," he added.

Even before the 1987 law was en acted, the state had an aggressive program to screen preschool students. The state's Medicaid program required eligible children to be screened for lead, and private doctors were encouraged to screen their patients. As a result of these efforts, half of the state's 440,000 preschool-age population was tested for lead poisoning between October 1988 and September 1989. According to the health department, 776 children were identified as having unacceptably high blood-lead levels..

School officials said that so far, no students have been excluded from school because of the new regulation. They said they were giving students and their parents a little leeway in complying with the rule.

In Quincy, for example, kindergartners have been allowed to at tend school if they show proof that they have been tested or have made an appointment to be tested.

Michael Grady, the medical director for the Boston school district,said school nurses were currently re viewing the medical records of kindergartners and other new students to see if any medical procedures were missing from their files. He said the school system would contact the parents of pupils who had not been tested for lead to try to ensure that all students were in compliance by later this fall.

"As long as people think there is a worthwhile benefit to any individual student, then people won't mind doing it,'' Dr. Grady said.

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