WASHINGTON -- In a major public health policy shift, the federal government plans to recommend that all children be tested for lead exposure by age 2 and that swifter action be taken to help those with moderately elevated lead levels in their blood, public health experts say.
The impetus for the new recommendation is a growing body of scientific evidence that lower levels of lead contamination are more damaging to brain development than previously recognized.
"For the first time in history, we're recognizing that small amounts of lead damage kids' brains," said Dr. Herbert Needleman, an authority on lead poisoning who served on a scientific panel that advised the government on the new lead standard.
"You can't wait until the kids get sick -- you've got to find it before it gets into the kids," said Dr. Needleman, a professor of psychiatry and pediatrics at the University of Pittsburgh School of Medicine.
The problem is epidemic in Baltimore, where an estimated 60 percent of children have blood lead levels above the standard, said Dr. Ellen Silbergeld, a professor at the University of Maryland Medical School and an expert in the field of lead poisoning.
The federal government's move "is extremely significant," she said. "Right now less than 5 percent of children are tested for lead. So we are talking about an enormous jump in testing."
Identifying lead poisoning is difficult without testing because children don't always show symptoms.
Only five or six children in the past decade in Baltimore showed obvious symptoms of extreme poisoning such as convulsions or unsteadiness, said Dr. Julian Chisolm, a pediatrician who is director of the Kennedy Institute's lead treatment program and was a consultant for the committee that recommended the policy change.
The tests provide a warning system for physicians and parents to prevent further environmental exposure. "When we get in early, the risk of long-term damage is much less," Dr. Chisolm said.
However, the testing will also place a larger burden on state and city health departments, which will be forced to deal with a vast increase in cases. Dr. Silbergeld estimates that if all Baltimore children are tested, a five- to ten-fold increase in poisonings will be uncovered.
But she said she wonders whether the money will be available to test those children who are uninsured.
The recommendation that all children be tested for lead exposure also will put parents and pediatricians on notice that the risk for middle-class youngsters is greater than recognized, health experts say. Lead poisoning had been perceived primarily as an inner-city problem.
Lead is a poison that is particularly harmful to the developing brain and nervous system. Once inside the
body, it is hard to extract and causes permanent damage.
The major source of lead in the home is dust and flakes from lead-based paint manufactured before 1977, although children also can absorb lead from drinking water, lead-based gasoline fumes and lead-contaminated soil.
Under the new recommendation, public health officials would be asked to test all children under the age of 2, the age group most likely to eat paint chips or ingest lead dust.
"The message is that every kid is potentially at risk. This isn't just ghetto kids, this is every one of our kids need to be tested," said Don Ryan, executive director of the non-profit Alliance to End Childhood Lead Poisoning.