In a marked policy shift, the U.S. Centers for Disease Control last week recommended that all children be tested for the presence of lead in their blood by their first birthday.
At the same time, the C.D.C.. toughened by 60 percent the standard for determining whether a child is at risk of becoming lead poisoned. Under the new standard, about four million children under the age of 6 would have lead levels that would trigger monitoring and intervention, about 10 times as many as were affected by the old standard.
“Lead is not to be taken lightly,” Dr. Louis W. Sullivan, the Secretary of Health and Human Services, said in announcing the new standards at a conference on childhood lead poisoning here last week. “It is the number-one environmental threat to the health of children in the United States.”
“These guidelines are an important milestone in the effort to achieve the elimination of childhood lead poisoning,” he said.
The new guidelines, which have been under development for more than two years, come in response to mounting scientific evidence suggesting that even low levels of lead can pose health risks to young children. 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 I.Q. scores.
“This is an important first stop,” said Dr. Herbert L. Needleman, a professor of psychiatry and pediatrics at the University of Pittsburgh’s medical school, and a leading researcher on lead, about the standards he helped draft. “By declaring this a real problem, there will be a demand made [for solutions.]”
Although the new standards, which are voluntary, were hailed by many health experts, some questioned whether there is sufficient money and expertise to carry out the new recommendations.
The C.D.C. has not estimated how much it would cost to host all young children and to provide follow-up care for those who need it, although it acknowledges that cost implications mean it will take at least two to three years to fully phase in the new recommendations.
The federal government currently spends about $8 million to test “tens of thousands” of children for lead, and is proposing $15 million for next year, C.D.C. officials said. The brunt of financing the new program, they said, will have to fall on state and local health departments.
At least one Capitol Hill veteran is not happy with that conclusion.
“With today’s new standards, the Administration has again put on the ‘white hat,’” said Representative Henry Waxman, Democrat of California. “But no meaningful follow-through is proposed.”
“Millions of children are about to be diagnosed with lead problems,” said Mr. Waxman, who is sponsoring a bill that would earmark $40 million for lead screening. “Yet we still do not have a policy that offers them a chance of recovery.”
Slow Phase-in
Under the new guidelines, all children would be screened for lead by their first birthday, and again by their second birthday. Under the old protocol, federal officials had said that screening programs should mainly focus on poor children or those thought to be at high risk for lead poisoning.
Only about 10 percent of these high-risk children have so far been tested, C.D.C. officials estimate.
According to the C.D.C., lead levels in children’s blood increase most rapidly between ages 6 and 12 months, and peak at 18 to 24 months.
High-risk children, such as those who live in a home built before 1960 that has peeling and chipping paint, who live in an older home that is undergoing renovation, or who have a sibling who is being treated for lead poisoning, should first be tested at 6 months of age, an expanded version of the guidelines state.
“Since virtually all children are at risk for lead poisoning, a phase-in of universal screening is recommended, except in communities where large numbers of or percentages of children have been screened and found not to have lead poisoning,” the C.D.C. says.
The new document also states that the most common lead test, a finger-prick test, should be replaced with a more accurate--and more costly--test that involves drawing blood from a child’s vein.
Because very few labs currently have the capability to analyze these test results, and because a cheap, easy-to-use testing instrument is at least two to three years away from development, the new guidelines will have to be phased in slowly, the c.D.C. acknowledges.
Under the new guidelines, children will be considered at risk of becoming lead poisoned if they have lead readings that exceed 10 micrograms of lead per liter of blood, a level 60 percent lower than the old standard of 25 micrograms, which was a trigger for medical treatment.
According to the C.D.C., more than one in six preschool-age children, or about three million nationwide, have blood-lead levels that exceed 15 micrograms. Although federal officials do not know how many young children have blood-lead levels that exceed 10 micrograms, they believe the total number of affected children could reach four million.
Children who have readings between 10 micrograms and 14 micrograms should be screened more frequently and monitored, the c.D.c. says, noting that a community with a large number of children in this range should begin prevention programs.
Ira child has a reading of between 15 micrograms and 19 micrograms, he should receive nutritional counseling, according to the guidelines. If these levels persist or increase, then the child’s environment should be tested and cleaned. Children who have more than 20 micrograms of lead per liter of blood need to get medical tests and perhaps undergo drug treatment, the C.D.C. says, while those with readings higher than 45 micrograms definitely need medical treatment. Readings above 70 micrograms are a medical emergency, the guidelines state.
Few Resources
While lauding the new guidelines, some public-health officials said they wished they had the money and personnel to carry them out properly.
“On some level, we are happy, because it will increase public awareness,” said Janet Loughridge, a health educator in the Cleveland Department of Health. “But as far as having the personnel, lab equipment, and resources, we don’t have it.”
The department, which tested 18,000 children for lead last year, “is struggling to keep up with the highest-risk kids,” she said.
“It’s either we find more resources, or what do we drop?” said Sharon Hipkins, the director of the bureau of personal health services for the Chester County Health Department in suburban Philadelphia. “Do we drop prenatal services? Nobody is talking about that.’
And while screening and education programs may be costly, “the real issue is the money for the abatement,” Ms. Hipkins added, noting that one house in her community recently had to undergo a $35,000 treatment to remove lead to benefit only one child.
Although most health experts said they believe that lead levels as low as 10 micrograms may pose health risks to children, others question whether the federal government actod too hastily in promulgating the lower lead standard.
“As you lower the [standard], you run the risk of not finding the kids who are above 25 and really need help,” said Jeffery Miller, the director of environmental health and government affairs for the Lead Industries Association, which represents lead producers and industrial users of lead products. “I am certainly not convinced that the science [behind the standard] is unanimous or indicative of consensus within the scientific community.”
“My sense is that it is greatly overdone,” Claire B. Emhart, a professor of psychiatry and reproductive biology at Case Western Reserve University, said of the new standard. “It is going to be wasteful of money and will leave a lot of parents unnecessarily anxious.”
"[The guideline] is not based on sufficient information,” said Ms. Emhart, who has done consulting work for the lead industry. “I don’t think one can say a specific level [of lead] causes a specific effect.”
“The science speaks for itself--18 studies,” Dr. Needleman responded to the charges of insufficient information. “That logic does not apply in the face of good epidemiology.”
