Prevention and Intervention for Lead Exposure

Promoting environmental health in Wisconsin means protecting residents from toxic substances, such as lead. Lead can affect a child’s growth, brain development, lifelong health, and future potential. Preventing lead exposure is critical because there is no safe level of lead in the human body. Early detection through blood lead screening programs that are accessible to children and adults at high risk for lead exposure is important. Early intervention and comprehensive follow-up when lead poisoning is detected also protects the child or adult from prolonged exposure.

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About Lead

Childhood lead poisoning is a significant problem in Wisconsin. Wisconsin consistently ranks in the top 10 states in the nation for number of lead-poisoned children. These resources provide an overview of the damaging effects of lead on children throughout their lives.

Intellectual Impairment in Children with Blood Lead Concentrations below 10µg/dL (PDF, 118 KB): A study on the relationship between blood lead levels and IQ indicates that blood lead levels below 10 µg/dl can cause a decline in IQ points (April 17, 2003 NEJM; 348:16; 1517-26).

National Center for Healthy Housing: Offers a broad range of information about research, funding, innovative strategies, and more about lead hazards and other health risks in the home.

Blood Lead Testing

Children are at risk for lead poisoning when they are exposed to lead hazards. Find out what the risks of exposure are in Wisconsin and at what ages children should be tested.

Wisconsin Blood Lead Screening Recommendations (PDF, 23 KB)  - This is a two-page summary of recommendations for assessing a child's risk for lead poisoning.

Coping With Your Child's Diagnosis of Lead Poisoning (PDF, 590 KB)

Wisconsin Women, Infants, and Children (WIC) Nutrition Program Clinic Locations - WIC clinics may offer blood lead tests to enrolled clients.

Wisconsin Local Health Departments - Local health departments can assist in identifying places to obtain a blood lead test and provide follow-up services to lead-poisoned children.

Developing Brains and Lead

Young children are most vulnerable to the effects of lead and other environmental toxins on the brain. The results can be seen as delays in growth, behavior, and learning, which in turn can have an impact on school success. Information on the structure and growth of the brain, the impact of environmental toxins, how to nurture brain development, and screening to identify delays can be found on these publications.

Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention (PDF, 922 KB) - Details the systematic impact of lead exposure on every body system and challenges the nation to engage in primary prevention so that young children are protected from these irreversible lifelong learning, behavior and health effects. Advises the Centers for Disease Control and Prevention (CDC) to lower the intervention blood lead level from 10 micrograms per deciliter (mcg/dL) to 5 mcg/dL.

In Harm's Way: Toxic Threats to Child Development - Describes how byproducts of an industrial community are contributing to challenges children face to learn, exercise self-control, and participate respectfully in social groups.

Developmental Surveillance and Screening of Infants and Young Children (PDF, 132 KB) - Provides recommendations for screening infants and young children and intervening with families to identify developmental delays and disabilities in the primary care setting to assure access to early intervention services.

Lead and Pregnancy

Lead has long been recognized as a reproductive toxin in both men and women. A history of maternal lead exposure, prenatal and postpartum lead exposures, and blood-lead levels can be a concern. Concern about all possible pathways of lead exposure has raised questions about reproductive health, prenatal exposure, and breastfeeding. These resources explain the risks and provide recommendations.

CDC Guidance for the Identification and Management of Lead Exposure in Pregnant and Lactating Women (PDF, 4.2 MB) is based on scientific data and practical considerations regarding preventing lead exposure during pregnancy, assessment, and blood-lead testing during pregnancy, medical and environmental management to reduce fetal exposure, breastfeeding, and follow-up of infants and children exposed to lead in utero.

Wisconsin Local Health Departments can assist in establishing prenatal care and newborn services to women.

Wisconsin Women, Infant, and Children's (WIC) Nutrition Program Clinic Locations provide pregnant women and new mothers who are income eligible, education and support for adequate prenatal nutrition and breastfeeding.

Sources of Lead

Lead in Paint

Exposure to lead-based paint (LBP) is the major source of lead poisoning for children in Wisconsin. When lead paint is intact, it is unlikely to cause exposure. The risk of exposure increases as the paint breaks down into smaller particles. The smaller the particles, the more easily they are dispersed, become accessible to children, and are absorbed by the body. If lead paint is allowed to deteriorate due to normal wear (moisture damage, temperature changes, friction, or impact), or when paint or varnish are deliberately disturbed by renovation activity, house dust and soil become contaminated. The resulting lead-tainted dust enters a child’s body through normal hand-to-mouth activity.

Routes of Exposure

  • The most common route of exposure is from the lead dust created by deteriorating LBP or renovation activities which can stick to fingers, toys, soil, food, and other accessible surfaces. Young children are then likely to ingest the lead dust through normal hand-to-mouth activity.
  • Another route of lead exposure is when children chew on things, such as windows and window sills, doors and door frames, stairs, railings and banisters, porches, fences, and/or furniture.
  • Even surfaces that are covered with a new layer of paint, can be a source of exposure is they are a friction surface or consistently rub together, exposing underlying layers of LBP.
  • Lead in varnish is typically found on floors, stairs, doors, windows and wood trim and even old baby cribs. Even if intact if a child chews on varnished surfaces, the child can ingest lead.

Disturbing LPB and Varnish is Regulated

LBP or varnish that is intact, undisturbed, and inaccessible to young children may not pose a lead hazard and should be left alone. If it is going to be disturbed, by state and federal laws the person doing the work must be a certified lead-safe renovation contractor.

Reliable Sources of Information on Lead in Paint and Varnish

The Lead-Safe Housing Rule The U.S. Housing and Urban Development (HUD) Lead Safe Housing Rule applies to all target housing that is federally owned and target housing receiving Federal assistance.

Residential Lead-Based Paint Hazard Reduction Act of 1992 (Title X) (PDF, 108 KB) The primary purpose of this Act is to develop a national strategy to build the infrastructure necessary to eliminate lead-based paint hazards in all housing as expeditiously as possible and to reorient the national approach to the presence of lead- based paint in housing to implement, on a priority basis, a broad program to evaluate and reduce lead-based paint hazards in the Nation's housing stock.

Lead in Air, Soil, and Water

Air

Lead in the air is a problem because people can breathe it in, and also because people can end up swallowing the lead dust found in soil and water. It is particularly bad because the lead in the dust and soil does not decompose or decay.

Lead dust particles in the household result from indoor sources such as old lead paint on surfaces that are frequently in motion or bump or rub together (such as window frames), deteriorating old lead paint on any surface, home repair activities, tracking lead-contaminated soil from the outdoors into the indoor environment, or even from lead dust on clothing worn at a job site. Lead paint chips and dust can get on surfaces and objects that people touch. Settled lead dust can re-enter the air when the home is vacuumed or swept, or when people walk through.

Reliable Source of Information on Lead in Air

The U.S. Environmental Protection Agency (EPA) has a national database that shows you what types of lead sources make up the total amount of lead in the air.

Soil

Lead has made its way into the soil around homes through several different routes:

  • Paint
  • Leaded gasoline
  • Environmental emissions

Lead is naturally occurring, and can be found in high concentrations in some areas. In addition, soil, yards, and playgrounds can become contaminated when exterior lead-based paint from houses or buildings flakes or peels and gets into the soil. Lead in soil can be ingested as a result of hand-to-mouth activity that is common for young children and from eating vegetables that may have taken up lead from soil in the garden. Lead in soil may also be inhaled if re-suspended in the air, or tracked into your house thereby spreading the contamination.

The EPA defines soil lead hazard as 400 parts per million (ppm) in play areas and a 1,200 ppm average for bare soil in the rest of the yard.

Reliable Source of Information on Lead in Soil

If your soil has lead, or if you are not sure, please view the publication, Human Health Hazards: Lead in soil from exterior lead paint P-45015 (PDF, 165 KB), to get advice for homeowners.

Water

Lead is typically not found in drinking water. However, lead can enter drinking water through corrosion of plumbing materials, especially where the water has high acidity or low mineral content that corrodes pipes and fixtures. The EPA estimates that drinking water accounts for 10-20 percent of human exposure to lead.

Homes built before 1986 are more likely to have lead pipes, fixtures, and solder.  Beginning January 2014, changes to the Safe Drinking Water Act reduced the maximum allowable lead content of pipes, pipe fittings, plumbing fittings, and fixtures from 8 percent to 0.25 percent.

The only way to find out if a home has high levels of lead in the drinking water is to test the water. If it has not been tested, there are several things that can be done to reduce ingestion of lead from drinking water:

  • Do not drink, cook, or make baby formula with water from the hot water tap.
  • Consider purchasing a filter certified for lead removal, or purchase bottled water.
  • Replace the plumbing or service line, or lead-containing faucets.

NOTE: Boiling the water WILL NOT reduce the amount of lead; it will concentrate the lead in water.

NOTE: Bathing IS NOT TYPICALLY A PROBLEM, unless the one bathing is ingesting the water; lead does not enter the body through your skin.

Reliable Source of Information on Lead in Water

For more information on lead contamination in water, visit the Centers for Disease Control and Prevention (CDC) website on Lead and Water.

Lead in Products

Toys/ Products for Children

Remedies/ Candies

  • Warning: Sindoor Contains Lead - A product called "SINDOOR" is often added to food as a food coloring. The Food and Drug Administration (FDA) issued an alert on Dec. 17, 2007, warning consumers not to use the Swad brand Sindoor product because testing conducted by the Illinois Department of Public Health indicated this product contained very high levels of lead, sometimes as high as 87%.
  • Toxic Treats (poster in English or in Spanish) - California and U.S. health officials have detected dangerous levels of lead in 112 distinct brands of candy – most of them made in Mexico. One in four candy and wrapper samples have tested high since 1993, records show.
  • California Department of Public Health tests candies annually that are suspected to contain lead and posts the detected levels on this website.

Lead in Other Products

Public Health Intervention

Treatment of lead poisoning involves a team of professionals to manage the medical, environmental, and social care required by the child and family. Public health plays a specific role in determining the source of lead exposure by evaluating the child in environments where they spend a lot of time and conducting lead hazard investigations of those places.

Handbook

The standards of practice of the Wisconsin Childhood Lead Poisoning Prevention Program and its agents, i.e., local health departments, are delineated in this handbook, Wisconsin Childhood Lead Poisoning Prevention and Control Handbook for Local Public Health Departments, P-00660 (PDF, 8 MB) .

Forms

These links go to web pages where the forms are available as either a Word-fillable document or a PDF.

Blood Lead Lab Reporting F-00017 (PDF, 22 KB)

Nursing Case Management Report/Case Management of Children with Elevated Blood Lead Levels F-44771A

Medicaid Targeted Case Management Face Sheet - Childhood Lead Poisoning F-44771AA (PDF, 53 KB)

Nursing Case Closure Report/Case Management of Children with Elevated Blood Lead Levels F-44771B

Property Investigation Report/Case Management of Children with Elevated Blood Lead Levels F-4471C

Property Investigation Closure Report/Case Management of Children with Elevated Blood Lead Levels F-44771D

Toolkits and Other Resources

Use this webpage for toolkits and other resources.

Lead-Free Kids for a Healthy Future: Tools and Resources for Community Awareness - a webpage with strategies and resources for community outreach for lead poisoning awareness building.

For more information

Wisconsin Local Health Departments - Children with lead exposure are followed by Wisconsin local health departments. Health care providers and parents can locate the health department serving their community at this site.

Wisconsin Statutes and Administrative Rules - Wisconsin has a number of statutes and administrative rules with respect to childhood lead poisoning prevention, such as for local health departments, in child care centers and other facilities and in other departments.

Lead Poisoning Treatment

Preventing disease and promoting healthy life styles is an important role for primary health care providers. Educating families with young children about lead hazards and the effects of lead poisoning can be part of routine pediatric well-child visits. Knowing when to test, how risk is determined, and how to treat lead poisoning are the next steps. The following resources provide standards of care for lead poisoning.

  • Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention (PDF, 922 KB) - While there is no level of lead in blood that is safe, the Centers for Disease Control and Prevention (CDC) recommends that children with blood lead levels (BLLs) of 5 micrograms per deciliter (mcg/dL) or above get some follow-up action.
  • Managing Elevated Blood Lead Levels Among Young Children - Recommendations from the CDC Advisory Committee on Childhood Lead Poisoning Prevention Program. It provides basic standards and principles of medical case management. The protocols for care are the same but the reference value for the BLL was changed in 2012 from 10 mcg/dL to 5mcg/dL.

The CDC recommendations for clinical intervention with a child with a BLL of 5mcg/dL or greater are:

  • Confirm a capillary blood lead test with a venous draw within 1 to 3 months.
  • Have child tested on the appropriate follow-up testing schedule.
  • Get a complete history and physical exam on the child.
  • Order the appropriate laboratory tests on the child such as tests for low iron or anemia.
  • Monitor the child's growth and development, especially as the child ages and enters school.
  • Provide education to the family on the sources of lead and how to reduce any lead hazards found.
Additional Resources

Parents: Look Out for Lead (PDF, 92 KB)

What You Should Know about Your Child's Blood Lead Results (PDF, 861 KB)

Blood Lead Levels in Children: What Do Parents Need to Know to Protect Their Children? (PDF, 292 KB)

Reliable Sources for More Information

Developmental Surveillance and Screening of Infants and Young Children (PDF, 313 KB) - Provides recommendations for screening infants and young children and intervening with families to identify developmental delays and disabilities in the primary care setting to assure access to early intervention services.

Wisconsin Local Health Departments - Local health departments follow up on children with elevated blood lead levels. The link provides contact information for local health department personnel.

Lead in Occupations/Hobbies

Lead is one of the most common exposures found in industry and is a primary cause of workplace illness. If you work around products or materials that contain lead, there a chance you could be exposed. Certain jobs have been known to put workers at risk of lead exposure:

  • Artists/ Painters
  • Construction Workers
  • Auto Repairers
  • Glass Manufacturers
  • Lead Manufacturers/ Miners/ Refiners/ Smelters
  • Plumbers/ Pipe Fitters
  • Welders
Routes of Exposure

Lead-emitting industries such as smelters and battery manufacturing plants can cause lead contamination of air, soil, and food grown in contaminated soil. Adults working in these industries or other hobbies or occupations involving exposure to lead may be directly exposed and/or may carry lead-contaminated dust home to their families on their hair, clothing, and shoes. Adults may contaminate their vehicle if they do not shower and change their clothes, including their shoes, before entering the vehicle. Tools or other items used on the worksite should be kept in the trunk of the car.

A CASE IN POINT: A child in Wisconsin was unknowingly poisoned due to the parent's occupation. Each day, the parent who is a contractor would throw his lunchbox that he used on the worksite into the back seat where the child's car seat was located. Consequently the car seat was found to have high levels of lead dust and the child was poisoned from sitting in it.

Keep Yourself and Your Family Safe from Lead
  • Eat and drink in areas where lead-containing products are not being handled or processed.
  • Wear proper Personal Protective Equipment.
  • Use effective lead removal products to clean your hands (washing your hands with soap and water WILL NOT be enough to remove lead residues).
  • Shower and change your clothing and shoes after working around lead hazards.
  • Store any equipment from your worksite (e.g., lunchbox, tools) in the trunk of the car.
  • Wash your work clothing separately from the family's laundry.
  • Work in well-ventilated areas.
  • Talk to your employer about other lead-safe practices.
Reliable Sources for More Information

Reproductive Health (CDC)

Protecting Workers from Lead Hazards (PDF, 21 KB) - Occupational Safety and Health Administration (OSHA) 

Lead (OSHA)

 The Effects of Workplace Hazards on Female Reproductive Health (PDF, 296 KB) (CDC/National Institute for Occupational Safety and Health)

Nutrition and Lead

Regular well-balanced meals are important for adequate growth and development in all children. While recent research indicates that additions to an age-appropriate diet may not help lower blood lead levels, there is evidence that adequate iron intake can decrease lead absorption. Iron deficiency, like lead, can also have effects on children's development. Families of children with lead poisoning that are income eligible can receive nutritional support from WIC.

Nutrition and Childhood Lead Poisoning - Chapter 8 of the Wisconsin Childhood Lead Poisoning Prevention and Control Handbook for Local Public Health Departments, P-00660 (PDF, 8 MB)

 

Managing Elevated Blood Lead Levels Among Young Children - Chapter 4 describes the research about the effects of dietary components on childhood lead poisoning.

Wisconsin Women, Infants and Children (WIC) Nutrition Program Clinic Locations - Children at risk for a poor diet and whose family is income eligible can receive education and support for improving or maintaining nutritional status.

Recommendations to Prevent and Control Iron Deficiency in the United States Vol 47, No RR03;1 04/03/1998 (PDF, 326 KB) - In children, iron deficiency causes developmental delays and behavioral disturbances, and in pregnant women, it increases the risk for a pre-term delivery and/or delivering a low-birthweight baby.

Last Revised: July 26, 2016