Know the Risks for Children: Lead Poisoning Prevention Week

Did you realize your dream of raising your family in an older home or urban area with “character”?

Do you have or oversee children in a school or daycare built before 1978?

Are you concerned about the health and welfare of kids living in older, disadvantaged (and often industrial) areas of your community?

Then you need to be concerned about lead poisoning.

National Lead Poisoning Prevention Week is October 20-26, 2013

Prevent lead poisoning. Get your home tested. Get your child tested. Get the facts!

Rates of childhood lead poisoning have fallen dramatically over the past few decades after the removal of lead from gasoline, yet it is still considered the most preventable environmental disease among young children, with approximately half a million U.S. children having elevated blood lead levels. Children under age 6 are most at risk for lead poisoning and its effects due to their rapidly developing bodies and brains and their tendency to put things in their mouth. According to Dolores Weis, Executive Director of Improving Kid’s Environment (IKE), an Indiana-based non-profit focused on reducing environmental health threats for children, contamination with just a small amount of lead can lead to permanent, lifelong health issues including behavior and learning problems (such as hyperactivity), slowed growth, hearing problems, and aggressive patterns of behavior. These are real and serious issues with effects felt across our society:

• Childhood lead poisoning can reduce IQ levels by 4-7 points and these deficits have been shown to persist through adulthood – meaning more kids needing special help to succeed in school and more adults who may struggle finding work in today’s high-skill economy
• Significant data now shows a strong correlation between childhood lead levels and adult violent crime rates, both across the U.S. and internationally – elimination of leaded gas has had a significant impact on reducing crime rates over the past 30 years

A Legacy of Contamination

The biggest source of ongoing childhood lead poisoning is lead-based paint. “We have a legacy that must be addressed – the legacy of deteriorating lead-based paint” says Weis. And, as outlined in two videos produced by IKE and WFYI, central Indiana’s public TV station (with support from the Indiana and Marion County Public Health Departments), this is not just an issue for blighted neighborhoods, but is also a real risk for middle and higher-income families renovating an older home. These videos make the issue very clear and real and are worth the 15 minutes viewing time.

Contaminated soil is also a major source of childhood lead poisoning. “Lead dust gets into the soil around homes from paint on the house, windows and porches and children ingest the lead when playing in the yard or when leaded soil is tracked into the house on shoes” say Weis. Improving Kid’s Environment has received several EPA (Environmental Protection Agency) grants to do home lead testing and repairs and Weis notes that the highest soil lead levels are along the edges – or dripline – of houses, and close to roads where decades of leaded gas emissions have built-up. But it is important to be aware that lead contamination can be found in a variety of sources including those below.

Lead Exposure Sources:

Paint in homes, schools and daycares built before 1978.

Older painted playground equipment.

Water pumped through leaded pipes.

Imported items including clay pots and painted toys.

Certain consumer products such as candies, make -up and jewelry.

Certain imported home remedies.

What can you do?

According to the CDC, “stopping a child’s exposure to lead from leaded paint, house dust, or any other source is the best way to prevent the harmful effects of lead.” Testing young children at high risk for lead poisoning is one important step and the CDC has a short checklist to help parents assess the risk to their family. Ideally testing should happen by age 1 or 2. However, there are a number of steps parents can take to minimize potential lead exposure:

• Talk to your state or local health department about getting your home/paint lead tested
• Inspect and maintain all painted surfaces to prevent paint deterioration
• Regularly wet-mop floors and wet-wipe window components
• Make sure your child does not have access to peeling paint or chewable surfaces painted with lead-based paint
  • Close and lock doors to keep children away from chipping or peeling paint on walls and apply temporary barriers such as contact paper or duct tape, to cover holes in walls or other sources of lead
• Wash children’s hands, pacifiers and toys often
• Use only cold water to drink and prepare food or baby formula
• Do not use containers, cookware or tableware to serve or store food that are not certified lead-free
• Prevent children from playing in bare soil around your home
  • Plant shrubs next to the home and cover exposed soil with grass or mulch
• Teach children to wipe and remove their shoes and wash hands after playing outdoors
• Pregnant women and children should not be present in housing built before 1978 that is undergoing renovation
• Ensure that home renovation contractors are lead-safe certified and follow lead safe work practices

Finally, if your family has been contaminated with lead or you are concerned about possible exposure, make sure your children are eating frequent well-balanced meals containing rich sources of iron, calcium and vitamin C which together can help reduce the absorption and harmful effects of lead. This CDC brochure provides more detail on how a healthy diet and protect your children.

For more information on Improving Kid’s Environment’s efforts to alleviate health risks to children – or to make a needed donation for this important work – please visit IKE’s home page.

Radon & Lung Cancer: Keeping Your Kids Safe from the Ground Up

Editor’s Note: In honor of Pediatric Safety’s 4 year bloggiversary, we are publishing 4 of our favorite posts from the past, one each Friday for four consecutive weeks. This is our 3rd: an overview of radon and it’s tie to lung cancer – in particular, the increased risk of childhood leukemia. It was originally posted in January 2010 by Jennifer Taggart – aka The Smart Mama. Our thanks go out to Jennifer for opening our eyes! ***************************************************************************************************************************

While we are trying to reduce exposure to toxic chemicals, we often overlook potentially one of the greatest risks in our home – radon, a radioactive gas. The US Environmental Protection Agency (EPA) estimates that radon is the number one cause of lung cancer among Safe from the Ground Up non-smokers. Surprising, right? I would have guessed secondhand smoke. The EPA estimates that radon causes 21,000 lung cancer deaths each year.

Another cause for concern is that recent research suggests that children who live in homes with high radon levels may have an increased risk of developing childhood acute lymphoblastic leukemia (ALL). The research found that children exposed to “intermediate” levels of radon had a 21% higher risk of developing ALL as compared to children exposed to the lowest levels. Children exposed to the highest levels of radon relative to those with the least exposure had a 63% greater risk of developing ALL.

Plus, January is National Radon Action Month, so this is the perfect time to talk about radon and what you can do to reduce your exposure.

But first, you are probably thinking what the heck is radon? Radon is an odorless, tasteless, invisible gas produced by the decay of radium. Radium, in turn, is produced by the decay of naturally-occurring uranium present in soil, rock, and ground water. Certain areas in the United States have a higher potential to have elevated radon levels because rocks with higher uranium levels are located in those areas, but radon can be found all over the US. The EPA estimates that nearly 1 out of every 15 homes in the US has elevated radon levels. The Office of the Surgeon General recommends that all homes be tested for radon.

As a gas, radon escapes rocks and soils by moving through what are known as soil pore spaces and rock fractures. Outside, radon gas isn’t a problem because it disperses. Typically, the concentration of radon in outdoor air is 0.4 picoCuries per liter of air (pCi/L). But radon in homes and other buildings can be a problem. Your home’s air pressure is usually lower than air pressure in the soil around your home, so your house can suck in radon like a vacuum through cracks, utility entries, seams, and other openings in the foundation, as well as from uncovered soil in crawl spaces. Radon can be a problem indoors because it can build up to unhealthy levels. The EPA recommends that you take action to reduce radon levels if testing shows radon above 4 pCi/L.

Radon is a very heavy gas, so it tends to accumulate in basements or at the floor level. Thus, occupied basements, houses on slabs and houses with rooms cut into hillsides are the ones most likely to have high radon levels.

Because radon is odorless and colorless, it has been called the silent killer. Not only are there no signs that radon is present in your home, there are no signs that you are being exposed. It causes no symptoms that you might notice and the harmful effects are delayed many years. Once exposed, there is no treatment.

Radon can also enter your home through your water if the water supply contains dissolved radon. Radon enters water as bubbles from radium decaying next to the water. These bubbles easily escape when the water is agitated, so most surface water supplies have low radon concentrations. You also ingest some radon when you ingest water. However, the risk of lung cancer resulting from inhaling radon is far greater than the risk of stomach cancer from ingesting water with radon in it.

If your home’s water supply is from a municipal system, the mixing, treatment, and long residence time (the time it takes the water to make it from the treatment plant to your home) result in dilution and release of radon. By the time it reaches your tap, it is highly unlikely that you will have radon present, unless it is a very small public municipal system. However, a home that is supplied by a private groundwater well may have radon enter the home from the well water. But, radon in water can be readily treated.

If radon gas is present in your home, every time you inhale you get a dose of radioactivity in your lung. Radon gas decays. When radon decays, small radioactive particles are released. If you inhale radon (or the particles), once in the lungs, the tiny particles damage the cells that line the lung. These particles release small burst of energy as they decay. These small bursts of ionizing radiation can affect DNA, leading to mutations that may turn cancerous. The latency period for developing lung cancer from radon exposure is twenty to thirty years.

The increased risk of lung cancer from radon exposure is greater if you smoke. But even if you don’t smoke, elevated concentrations of radon in the home pose a fairly significant increased risk of cancer. For a home with 4 pCi/L, the lifetime risk of cancer is 7.3 out of 1,000 persons. That is really high, surprisingly high, especially when you compare it with the 1 in 1,000,000 risk factor generally used to regulate contaminants in our environment. And, “scientists are more certain about radon risks than from most other cancer-causing substances.”

Research has not yet determined whether children are at a higher risk from radon than adults. However, some children’s health advocates have suggested that children may be more sensitive because they have higher respiratory rates than adults. Also, the EPA has determined that exposure to carcinogens in the first two years of life is more significant, and a factor of 10 should be applied. Data generated from Japanese atomic bomb survivors suggests that exposure before the age of twenty years may have more significant health effects than exposure later in life. The American Academy of Pediatrics concludes that “until further data are available, it seems prudent to assume that the risks to children are at least as large as those determined in occupational studies.”

The EPA has developed a map that generally predicts radon levels in three general areas of the United States. But, you cannot use the geologic potential to determine the actual radon levels in your home. Some overlying soils with low uranium levels nonetheless have high radon levels, and vice versa. You must test your house to determine actual radon levels.

The good news? It is easy and relatively inexpensive to test for radon. You can purchase do-it-yourself kits from your local hardware store or online. The National Radon Program Services at Kansas State Univ. has test kits available for online purchase (you must create free account to access). Also, many state programs offer free or low cost test kits – just contact your state’s radon office.

Short term and long term test kits exist. A short term test is typically exposed to your home’s air two to seven days before being sent to a lab, and long term tests are usually exposed 90 days. If you buy a kit from a hardware store or online, make sure the test kit is state-certified. A study by Consumer Reports found long term tests more reliable than short term test kits. Radon levels can vary day to day, so a 90 day exposure period gives a more accurate reading of a home’s average radon level. Of the seven short term kits tested by Consumer Reports, only the RTCA charcoal canister was accurate enough for Consumer Reports to recommend. Two of the kits, Accustar’s Short Term LS Radon Test Kit CLS 100i and Kidde’s Radon Detection Kit 442020, under reported radon levels by almost 40%! Of long term test kits, Consumer Reports recommends, and found most accurate, Accustar’s Alpha Track Test Kit AT100. Of course, follow the instructions, including maintaining closed house conditions. You can also hire a trained contractor to test your home. Contact your state’s radon office for a list of qualified contractors.

If your child is in a daycare or school, ask if the building has been checked for radon. A lot of times daycares are in the basements of buildings, and bottom level rooms and basements are more likely to have high radon levels than other rooms. Of course, keep in mind that the lung cancer risk from radon exposure is related to both the radon level and the length of time one is exposed. Consequently, if the exposure time is short, even large radon concentrations may not contribute to a significant risk.

If the testing determines that radon levels are elevated in your home, then fix the problem. Radon reduction systems can reduce radon levels in your home by as much as 99%. EPA recommends fixing your home if one long term test, or two short term tests, show radon concentration levels above 4 pCi/L (or 0.016 working levels, also used in the industry). However, there is no safe level of radon established. EPA also recommends that you consider fixing your home if the radon level detected is above 2 pCi/L. If you have a radon problem and you decide to fix it, the EPA’s Consumer’s Guide to Radon Reduction has a good discussion of available technologies and how they work for different foundation types.

If you have determined that elevated levels of radon are present in your drinking water, then you can fix it before it enters your home with a point of entry system. A point of entry system will usually consist of granular activated carbon filters or aeration. Granular activated carbon may be less expensive to install, but the filters can collect radioactivity thereby necessitating special handling upon disposal. An aeration system may cost more to install. A point of use system is also an option and will remove radon at the tap, so from your drinking water. However, a point of use system will not eliminate exposure to radon escaping from other water uses in the home.

Finally, sealing cracks and other openings to prevent radon from entering the home is an easy approach to radon reduction. However, the EPA does not recommend the use of sealing alone as a method to reduce indoor radon concentrations. Sealing has not been shown to lower radon levels significantly or consistently. Identifying and permanently sealing all the places where radon is entering is difficult. A home’s normal settling will also open new ways for radon to enter.

Radon may sound scary, but it is easy to test for it and inexpensive, and the solutions are relatively easy. And it isn’t just about living green, but about keeping your kids and yourself safe. From the ground up.

Are Your Kids at Risk from Lead in City-Grown Produce?

I am currently about halfway through completion of my Masters in Public Health and I am fascinated and motivated by everything I am learning and doing in the program. According to the website What is Public Health?, this discipline is “the science of protecting and improving the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention.” Basically we look at potential risks to the health of whole populations and try to prevent problems before they occur.

Unfortunately, sometimes the policies and interventions we promote can have unintended consequences. This was brought home to me by two recent news reports about urban gardening that I saw shortly after attending an inner-city community meeting about neighborhood soil lead levels.

After learning from geology professor and lead expert, Gabriel Filippelli, from Indiana University-Purdue University at Indianapolis, that most urban soil has elevated lead levels, often as much as 2-10 times the levels acceptable for children’s play areas – I was concerned to hear on the local radio that our city has seen great success with recent inner-city gardening initiatives, with produce from these gardens now making their way into local farmers’ markets. While it’s great to see efforts to improve the availability of fresh fruits and vegetables, the problem is that soil lead levels in these areas can be dangerously high; particularly if the gardens are in areas with pre-1978 housing, are located near major roads or freeways, or are situated within a few miles of former industrial areas. And the perils of lead in community gardens are not just an issue in my backyard. An article last week in The New York Times reported on a recent New York State Health Department study showing that about half the eggs they sourced from community gardens in the NY boroughs had detectable lead levels.

So What’s the Issue?

High lead levels are toxic to the brain – particularly for young children whose brains are rapidly developing. The damage to the brain from chronic lead poisoning – including reductions in IQ, memory problems, and difficulty concentrating – is permanent.

While much of the lead hazard these days is from residual lead paint in and around older homes, the soil in most urban areas has become permeated with lead over the decades due to our past use of leaded fuel and paints, and any former urban industrial activity. As a result, digging around in or eating food grown in city soil can potentially increase your family’s lead exposure. This becomes an even bigger concern if you shop at local farmers’ markets that may be sourcing produce from city gardens.

What Can We Do?

Getting the soil in your yard tested is a good place to start to determine your own risks – for your garden and your family. Many local health departments, university research centers and private labs will do soil tests for reasonable fees. However, if you know you have high lead levels – or are just concerned about the possibility – there are efforts you can make to reduce the hazard, including where you locate your garden, mulching, and creating raised garden beds with clean-sourced topsoil. The National Gardening Association provides a good overview of precautions you can take. An Australian website, Lead Action News, also provides good advice on dealing with lead contamination.

If you are worried about produce in local farmers’ markets, ask sellers about out the source of their fruits and vegetables. Are any of the gardens located within city – or even suburb – boundaries? What steps have been taken in these gardens to minimize lead contamination? If they can’t provide you with these details, then you may want to avoid buying produce that tend to absorb more lead from both soil and city air – such as root crops and leafy vegetables. The box below, from Lead Action News, gives an overview of lead absorption across different types of crops. And for crops that have low lead uptake, be sure to carefully clean all soil from the produce before storage and use.

HIGH uptake of lead: Lettuce, Spinach, Carrot, Endive, Cress, Beetroot

MODERATE uptake: Onion, Mustard, Potato, Radish

LOW uptake: Corn, Cauliflower, Asparagus, Celery, Berries

VERY LOW uptake: Beans, Peas, Melon, Tomatoes, Fruit, Paprika

Halloween 2011: Tips From the Experts to Keep Kids Safe

It’s that time again…

What is your little one going to be for Halloween this year?? A ghost, a gorilla…maybe even Gaga (…Lady Gaga that is)??? Well whatever he or she chooses to be this year, one thing we want them ALL to be is SAFE! With that in mind we’ve gathered up the best Halloween tips and tricks that we could find from the most reliable safety sources we know.

Full credit…and our thanks go out to them.

1. DRESSING FOR THE OCCASION: (AAP)

• Plan costumes that are bright and reflective. Make sure that shoes fit well and that costumes are short enough to prevent tripping, entanglement or contact with flame.
• Consider adding reflective tape or striping to costumes and Trick-or-Treat bags for greater visibility.
• Because masks can limit or block eyesight, consider non-toxic makeup and decorative hats as safer alternatives. Hats should fit properly to prevent them from sliding over eyes.
• When shopping for costumes, wigs and accessories look for and purchase those with a label clearly indicating they are flame resistant.
• If a sword, cane, or stick is a part of your child’s costume, make sure it is not sharp or too long.
• Do not use decorative contact lenses without an eye examination and a prescription from an eye care professional. They can cause pain, inflammation, and serious eye disorders and infections, which may lead to permanent vision loss.

2. OUT TRICK-OR-TREATING: (AAP and SafeKids)

• A parent or responsible adult should always accompany young children on their neighborhood rounds.
• If your older children are going alone, plan and review the route that is acceptable to you. Agree on a specific time when they should return home.
• Obtain flashlights with fresh batteries for all children and their escorts.
• Only go to homes with a porch light on and never enter a home or car for a treat.
• Because pedestrian injuries are the most common injuries to children on Halloween, remind Trick-or Treaters:
  • Stay in a group and communicate where they will be going.
  • Carry a cell phone for quick communication.
  • Remain on well-lit streets and always use the sidewalk. Never cut across yards or use alleys.
  • Only cross the street as a group in established crosswalks. Never cross between parked cars or out driveways.
  • If no sidewalk is available, walk at the far edge of the roadway facing traffic.
  • Don’t assume the right of way. Motorists may have trouble seeing Trick-or-Treaters. Just because one car stops, doesn’t mean others will!
• If you’re out driving:
  • Slow down and be especially alert in residential neighborhoods. Children are excited on Halloween and may move in unpredictable ways.
  • Anticipate heavy pedestrian traffic and turn your headlights on earlier in the day so you can spot children from greater distances.
  • Remember that costumes can limit children’s visibility and they may not be able to see your vehicle.

3. FOR THOSE WHO CAN EAT CANDY…: (AAP and AAPD)

• A good meal prior to parties and trick-or-treating will discourage youngsters from filling up on Halloween treats.
• Wait until children are home to sort and check treats. Though tampering is rare, a responsible adult should closely examine all treats and throw away any spoiled, unwrapped or suspicious items.
• Remind kids to brush before (and after) eating candy: Tooth decay and cavities occur when sugar reacts to bacteria and dental plaque. Brushing before candy consumption reduces the amount of bacteria and plaque on the teeth.
• Watch out for hard candy: Don’t just monitor the amount of sugar a child consumes, but also how long they keep sweet treats in their mouths. Kids should eat the candy right away, limit chewy candies that stick to teeth, as well as hard candies, which will be slowly eaten.
• Monitor overall candy consumption: There are two recommended options.
  • Keep candy consumption limited to a few pieces a day given with a meal or a snack.
  • Alternatively, have the child eat whatever the amount the adult decides at one setting, and then have them brush their teeth afterwards and give or donate the remaining candy.

4. …AND FOR THOSE WITH FOOD ALLERGIES WHO NEED TO BE CAUTIOUS: (KFAF)

• Plan an alternate activity, such as going to the movies, hosting a slumber party, or having a scavenger hunt around the neighborhood for safe treats or other items.
• When trick-or-treating, carry your child’s emergency medicines.
• Let the kids dress up and run house to house, while you carry a safe snack in case they want one. Bring wipes to clean the little hands first!
• Give neighbors safe Halloween treats in advance to hand out to your food allergic child.
• Prepare a container filled with safe treats in advance, and then swap it for the treats collected.
• Try a variation of the Tooth Fairy: Sort through unsafe candy, then leave it in a safe spot for a “Sugar Sprite” or “Candy Fairy” who exchanges it for a small gift, toy, or money. [
• Trade unsafe candy for allergen-safe treats or age-appropriate non-food items once your children return home. Non-food ideas include coloring books, storybooks, pencils, stickers, stuffed animals, toys, cash and play dough.
• If permissible, donate leftover candy to children who may not be able to go out and trick or treat.
• Check all ingredients. Remember that treat-size candy may have different ingredients or may be made on different machinery than the same regular-size candy.

5. FINALLY, MAKE SURE TO STAY IN TOUCH (AT&T)

• Make sure wireless phones are fully charged.
• Pre-program contact information of parents, neighbors and emergency services into your and your child’s speed dial, and be sure they know how to access these numbers with ease.
• Establish boundaries – Families should have in place a familiarized route for children to follow while out on the town. Consider a small tracking device that can easily slip into your child’s candy bag like the Garmin GTU 10 and follow them via PC or mobile phone.
• Set up periodic alarms with Halloween-themed tones as a reminder for trick-or-treaters to text or call home between candy collecting stops.

Wishing you and your family a safe, happy and healthy Halloween!!

********************************************************************************************************************

Resources:

1. American Academy of Pediatrics: Halloween Safety Tips
2. American Academy of Pediatric Dentistry: AAPD Offers Halloween Tooth To-Dos For A Fun and Healthy Holiday
3. Kids with Food Allergies Foundation: Take the Tricks Out of Treats
4. Safe Kids Halloween: A Night for Treats, Not Tragedies
5. AT&T: Halloween Safety Tips for Parents
   

The Littlest Victims of The Recession – Part II

I wrote several weeks ago about the effect the economic crisis was having on our littlest ones. How 44% of children’s hospitals were reporting increases in ER visits this year because people were avoiding insurance and doctor’s office visits they couldn’t afford, and delaying care until it was absolutely necessary. The message was clear: children and their parents, the people working night and day to care for them, were flooding ER’s across the country. And the effect this was having on our children’s health and wellbeing was starting to take its toll.

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