Ronnell Doughty looks healthy enough as he eats his hospital breakfast and watches cartoons on television.
Then a nurse at the Kennedy Institute for Handicapped Children picks up the 14-month-old boy and carries him down the hall for a ritual that is painfully familiar.
Ronnell starts to squirm and fuss as he is placed on a stretcher. Another nurse approaches with a syringe, and he begins to cry even before he feels the hypodermic needle in his thigh.
In half a minute, it is over. The toddler's tears stop as Elva White, his grandmother, comforts him.
Ronnell has lead poisoning. For four weeks last month he had to be hospitalized so he could receive almost daily injections of medicine designed to draw the hazardous metal out of his body.
He seems fine now, but his future may be dimmer because of where his family unwittingly chose to live 2 1/2 years ago -- in an old rented rowhouse in Waverly where Ronnell probably ingested the dust from lead-based paint.
Many less-severe cases of poisoning go undetected, and recent research suggests that lead's toxic legacy can last a lifetime for such youngsters, contributing to failure in school and on the job -- and perhaps even pushing children toward violent, anti-social behavior.
The number of poisoning cases severe enough to require hospitalization is deceptively small -- just a few dozen Maryland children per year. But state health officials estimate that as many as 166,000 youngsters under age 6 in the Baltimore-Washington area may be exposed to low, but still harmful, levels of lead.
Such levels of lead in the bloodstream seldom produce obvious symptoms and are well below what is now officially considered poisoning. But recent medical studies indicate that these levels can cause permanent neurological and physical damage, such as learning and behavioral problems and stunted growth.
"It's an enormous problem, and we are really not coming to grips with it," says Ellen K. Silbergeld, a University of Maryland toxicologist who heads Gov. William Donald Schaefer's advisory council on lead poisoning. "If this were an infectious disease, there would be a national uproar."
A 1984 federal study reported more than 11,700 poisoning cases in 26 cities across the country. In Maryland, there were 544 poisoning cases in 1989, with all but 41 of them in Baltimore, according to the state Department of the Environment.
But that's just the tip of an invisible epidemic that reaches beyond the city into the suburbs and rural areas, say state officials. Poisoned children generally show no symptoms, and most cases go undetected because only a fraction of the children at risk are ever checked.
"We have a serious public health problem that nobody is even looking for," charges Don Ryan, executive director of the Alliance to End Childhood Lead Poisoning, a Washington-based group of doctors, environmentalists and other experts.
The federal government, long accused by public health advocates of neglecting the problem, is showing signs of waking up. Federal health officials say lead poisoning is the most common environmental disease afflicting America's young children today, threatening far more youngsters than was previously thought.
The Bush administration has mapped out a five-year, $1 billion plan for eradicating lead poisoning, and has asked for $41 million in federal funding to screen children and to remove lead-paint hazards from homes.
But public health advocates say the increase in funding sought by the president is nowhere near enough to tackle the problem. And they contend that local, state and federal agencies already are failing to cope with the more limited number of serious poisoning cases.
A lack of both money and political will has allowed the lead problem to persist, say public health advocates. And Baltimore is no exception, even though the city once was a pioneer in efforts to curb lead poisoning.
"Maryland has been ahead of the game, but things are changing," says Patricia McLaine, lead poisoning prevention director for the state Department of the Environment. "We won't be able to do the job."
BANNED SINCE 1977
Throughout the nation, lead was widely used until about a decade ago in paint, plumbing, gasoline and food cans. It has been banned from household paint since 1977, and its use in fuel, food packaging and plumbing also has been sharply curbed.
This helps explain a decline in severe poisoning cases and the virtual elimination of lead-related deaths in the past 20 years, though a 28-month-old Wisconsin boy did die last year.
But lead poisoning today is largely a legacy of the metal's past popularity. About 3 million tons of lead can be found in paint inside or on the exterior of 57 million U.S. homes, nearly three-fourths of all houses built before 1980, according to a recent survey by the federal Department of Housing and Urban Development. Maryland has 500,000 homes -- 200,000 of them in Baltimore -- that were built before 1950, when lead paint was widely used.