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Faster testing for lead in children’s blood may help Concord’s very low testing rate

  • Dr. Betsy Cramer shows her daughter Evelyn, 3, the steps of taking blood for the lead test at Concord Hospital on Monday, Oct. 23, 2017. GEOFF FORESTER / Monitor staff

  • Dr. Betsy Cramer shows her daughter Evelyn, 3, the steps of taking blood for the lead test at Concord Hospital on Monday, Oct. 23, 2017. GEOFF FORESTER / Monitor staff

  • Dr. Betsy Cramer shows her daughter Evelyn, 3, the steps of taking blood for the lead test at Concord Hospital on Monday, Oct. 23, 2017. GEOFF FORESTER / Monitor staff

  • The LeadCare II allows physicians to measure the amount of lead in children’s blood. GEOFF FORESTER / Monitor staff



Monitor staff
Monday, October 23, 2017

If you’re wondering why New Hampshire has a very low rate of testing toddlers for lead poisoning – and why Concord has a rate that’s even lower – Gail Gettens of the state’s Lead Poisoning Prevention Program can explain.

“Imagine you’re a parent who has just taken a rambunctious 2-year-old to a well-child check,” she said. “Now the pediatrician is saying: Go across town and pin down your 2-year-old, who looks healthy and acts healthy, for a blood draw.”

In that case, even a helicopter parent might skip the whole thing. And that helps explain why only 20 percent of 2-year-olds in Concord have been tested for lead in their blood stream.

Since exposure to lead at a young age can cause permanent neurological problems, it’s important to spot exposure early so something can be done to remove the source of the lead – usually old lead paint, which remains a serious problem in a state where 60 percent of housing units were built before 1978, when lead paint was banned.

And that’s why health officials want to get more quick-testing units into pediatricians’ offices around the country.

“If we can find that, ‘Wow, this kid’s a little bit at risk now,’ we can prevent them from getting poisoned as they go forward, with just five minutes in the office,” said Dr. Thomas Albushies of Concord Pediatrics.

Albushies was part of a training session Monday at the practice, where he and Dr. Elizabeth Cramer demonstrated LeadCare2, a “point of care” device that can determine blood lead levels from a few drops of blood obtained via pinprick, known as capillary testing, rather than a blood sample taken from a vein, and can provide a result while patients are still in the doctor’s office.

The demonstration went well, although Dr. Cramer’s 3-year-old daughter’s lack of enthusiasm showed that a pinprick isn’t an entirely painless way to get a small blood sample.

State officials hope to get more doctors and private practices to buy and use the devices, which cost about $2,500 to install and about $8 to run a test. The system is designed to provide quick information to the state so it can track outbreaks of lead poisoning more quickly than with current methods.

“The information goes right to the state, so we can see high-risk areas,” Albushies said. “If we’re able to screen 90 percent of patients, it would tell us, ‘Wow, there are some places in Hopkinton, or in Concord, in Bow or in Pembroke that are particularly high-risk spots.’ ”

There is no real treatment for high lead levels in blood, aside from removing the source of lead from the environment.

Removing sources of lead is why the country began phasing out leaded gasoline in the 1970s, banned lead in most paint as of 1978, and in the 1980s banned lead in most other industrial applications – especially those that come in contact with the public, such as in solder used in drinking-water pipes.

Banning new uses of lead does not remove existing uses of lead, however, which is particularly a problem with lead paint on buildings. It’s rare that all old paint is removed from a building when new paint is applied, meaning many sources of lead pollution are waiting to be exposed.

“Any place where daily use will rub through to lower surfaces, where there would still be lead paint, can be a problem,” said Gettens. “If you think of a window lifted up and down, up and down, where those surfaces are rubbing across the other, or doorjambs or painted stairs.”

Children don’t have to eat paint chips to get poisoned, either.

“As (paint) is deteriorating or gets rubbed against, it generates a fine lead dust that even in trace amounts is a potent neurotoxin for young children. There can be dust on toys, pacifiers, hands, that you won’t even see,” Gettens said.

In a 2015 paper, the Centers for Disease Control and Prevention said exposure to even very low levels of lead – as little as 5 micrograms per deciliter, or five parts per 100 million – can harm children’s speech and language, hearing and visual skills, and even behavioral issues like impulse control.

A state law passed in 2015 set goals for testing levels, including an 85 percent rate of tests for 1- and 2-year-olds in cities like Concord that are designated as universal testing communities. About half of the state’s cities and towns are designated as targeted communities, without the hard goals for testing.

An attempt in 2017 to designate all the state’s cities and towns as universal communities failed.

One issue dogging the problem is liability when lead paint is found in rental housing. Removing all lead paint is expensive: The Environmental Protection Agency estimated a cost of $8 to $15 a square foot, which can many run to tens of thousands of dollars for an apartment building.

(David Brooks can be reached at 369-3313 or dbrooks@cmonitor.com or on Twitter @GraniteGeek.)