Lead Paint Dust : Renovations Stir Up New Poison Fear

Fleeing the suburbs to be nearer their jobs, young professional couples are buying and proudly restoring old houses and, in the process, inadvertently poisoning their young children with dust from lead paint.

Recent studies have found that even low levels of lead may impair children’s intelligence and learning potential, forcing public health authorities to reevaluate their estimates of the number of children at risk and to reconsider the level at which intervention should be required.

“There have been many sleepless nights feeling guilty about what we might have done to our children, just because we didn’t know,” said Allen Gibson, 32, a Charleston, S.C., attorney whose young son was poisoned during the remodeling of their century-old home.

Because the effects of low-level, asymptomatic poisoning are subtle, the Gibsons probably will never know whether their children have lost any intellectual potential. “I know you’re not supposed to get really wrapped up with the IQ level of your child,” said Allen’s wife, Wendy Gibson, 28, a homemaker. “But if any numbers have been knocked off our children’s IQ, we’ll never forgive ourselves.”

The main culprit in poisonings is paint in older homes, especially those built before the 1950s. The poor are disproportionately affected because they tend to live in the oldest housing. But members of the middle class are not immune and, with gentrification, more and more are falling victim.

In Millions of Homes

Like asbestos, lead paint can be found in millions of homes built before 1977, when the Consumer Products Safety Commission restricted the metal in household paint for sale. In a report to Congress last year, the federal Agency for Toxic Substances and Disease Registry estimated that about 12 million American children live in housing that contains lead paint at potentially toxic levels, and about 3 million to 4 million may have hazardous levels of the metal in their blood.

“Lead poisoning these days is the most common preventable disease in the pediatric age group,” said Dr. John Rosen, a professor of pediatrics at Albert Einstein College of Medicine in New York. “It’s a national disgrace.”

Lead from any source is harmful to children, whether from food contaminated by lead-soldered cans or improperly glazed dishes, water by lead in pipes and solder, or soil and dust by freeways or industry. However, lead paint continues to be the major single source of poisoning in the United States. (Although pencils are made of graphite, not lead, they may be a source of poisoning if they are covered with lead paint.)

A child can be poisoned by lead-tainted dust emitted from a painted surface that is cracked, water-damaged or peeling, even when the top layers are regular oil or latex paint. Even intact, uncovered lead paint can poison a susceptible child because it chalks and contaminates household dust. A baby teething on a door or windowsill, where lead paint was most often used, is also vulnerable, although most severe poisonings still occur from chronically eating paint chips. The higher the lead content, the sweeter they taste.

Stripping old paint can be nearly as perilous as removing asbestos. Sanding, scraping or burning it with a heat gun raises a fine, invisible dust or vapor that can be extremely toxic. Lead particles are distributed into the environment, coating the floors, walls, furniture and children’s toys with an invisible poison.

Although the phase-out of lead in gasoline in the early 1970s is generally credited with reducing the average level of lead in the general population, it did not end the hazard. In the last three to five years, there have been ominous signs from around the world that even this progress has been insufficient. Careful epidemiological investigations have reported the same unsettling conclusion: lead in young children, even at levels thought to be safe, appears to cause long-lasting if not permanent damage in cognitive ability.

Children More Susceptible

Adults can get lead poisoning, but children are more susceptible because of differences in metabolism and excretion of the metal. Adults absorb about 10% of the lead they ingest; children absorb about 50%. Women of childbearing age are also considered of special concern because lead crosses the placenta and can impair brain development in a fetus.

Health authorities recommend screening children up to 6 years of age. One- to 3-year-olds are considered most vulnerable because they are undergoing rapid neurological and physical development and are prone to put their hands and dust-covered objects in their mouths. At that age, children also are more likely to have iron deficiency, which makes them more susceptible to lead poisoning.

Lead attacks the brain, which is still developing in young children and the fetus. The metal can reduce a child’s intelligence and cause hearing problems, hyperactivity, impaired reaction time, impulsiveness and difficulty in persisting in a task. The effects are often permanent, even after medical treatment.

The Gibsons’ 3 1/2-year-old son, Walker, was poisoned by dust about a year ago when his father used a sander, a heat gun and a scraper to remove several layers of old paint from elaborate moldings and door frames in their newly purchased home.

“I was trying to bring out the detail of the wood--lovingly restoring an old home,” the Charleston attorney said.

Shared Picnic Lunches

Before moving in, he worked on the house on the weekends and his wife and son brought him picnic lunches which they shared on the floor. “Of course Walker thought it was great fun,” Wendy Gibson recalled. “He thought he was in some cave somewhere. We would pull over a box and sit down to eat.”

“I look back at it,” she said in a flat voice, “and cringe.”

“He would have a cookie or a sandwich in the midst of all this lead paint,” his father said. “It was the dust. We never saw him with anything (such as paint chips) in his mouth.”

Although Walker had no symptoms, his pediatrician recommended that he be tested for lead because of the remodeling. His level was more than twice the national average, and after moving into their new home, it climbed above 25 micrograms per deciliter of blood, the level considered toxic by public health authorities.

Frightened and nearly “hysterical,” Wendy moved him and her newborn son, Andrew, to Florida to stay with her parents while Allen worked with public health authorities to clean out the lead dust.

“We had so looked forward to involving ourselves in restoring a historic old home,” she said, “and then I just felt angry that we had bothered at all. I was ready to sell the house and move back.”

Not Warned of Danger

Besides the disappointment, there was bitterness that no one had warned her of the dangers. She called friends who had done similar work, and they, too, were unaware. “I don’t think people realize how common it is,” she said, looking out her window and watching workers scrape the paint off her neighbor’s equally historic home. “It is probably happening, and people don’t realize it.”

At relatively low levels, such as Walker’s, the effects of lead may be invisible to parents or doctors. It is only when such children are studied in populations that differences are noticed. Toddlers who were exposed to lead in the womb and in the first year of life score lower on cognitive development tests than other children.

Although the Centers for Disease Control recommend intervention at 25 micrograms of lead per deciliter of blood, that level is undergoing review and is expected to be lowered within a year. Recent epidemiological studies from Greece, Scotland and Denmark have found that children with blood lead levels as low as 10 and 15 micrograms per deciliter scored an average of 4 to 7 points lower on IQ tests than children who were not exposed.

Walker’s highest level was 31 micrograms per deciliter, and his brother, Andrew, now 15 months old, was tested at 1 year old and had a level of 11. For an individual child, however, it is virtually impossible to predict what effect low-level exposure will have because reactions and vulnerability can vary significantly. What damages one may leave another unchanged.

Epidemiologists’ Concern

Moreover, the loss of a few IQ points may have relatively little effect on an individual’s lifetime achievement. Indeed, much of the concern of epidemiologists is the effect on a population in which even low lead exposure significantly reduces the number of people with superior intelligence and raises the number who are below average.

Dr. Herbert Needleman, a professor of psychiatry and pediatrics at the University of Pittsburgh and a leading authority on lead and children, said the loss of IQ points from lead may not be as detrimental to a child’s future as the other effects of poisoning.

“The ability to persist in boring work is important because that’s what a lot of school is--very boring,” he said. “Distractibility, persistence, impulsiveness, frustration, all those things are affected by lead.”

Needleman studied asymptomatic lead-intoxicated children whose levels at the time they were measured did not exceed the then-higher federal health guidelines. For the high group, the average lead level was 35 micrograms per deciliter; the low group had an average of 24 micrograms.

In the first and second grades, the children with the higher lead levels scored lower on IQ tests and on scales measuring auditory and language function and attention span. Teachers who were unaware of the lead levels rated those with the higher exposure more distractable, disorganized, hyperactive and impulsive.

Likely to Be Held Back

By the fifth grade, those with the higher levels were more likely to be held back a grade or referred for special services.

By age 18 or 19, those with the higher levels had more reading disabilities, lower scores on vocabulary, grammatical reasoning and fine motor tests and slower reaction times. There were also more high school dropouts among the high-lead group.

Because many lead-intoxicated children do not have symptoms, particularly at low levels, poisoning cases may often go undetected. An Oakland couple, for example, did not discover that their children had been poisoned two years ago until their cat became sick. A veterinarian diagnosed lead poisoning. Subsequent tests on the couple’s two toddlers found enough lead in their blood to require hospitalization for chelation, the removal of lead from the blood. The children had been poisoned during the renovation of their Victorian home.

Some lead specialists speculate that poorer children are more likely to be tested for lead than higher-income youngsters because of a misperception that lead poisoning is only a poor person’s disease. Dr. J. Routt Reigart, a pediatrician at the Medical University of South Carolina and an expert on childhood lead poisoning, maintains that any neighborhood that has housing 60 to 100 years old has a problem. “I would almost bet on it,” he said.

Testing Begins

Health authorities in Charleston began testing low-income children for lead 16 years ago and found that about 40% had above 40 micrograms per deciliter in their blood, he said. But few affluent children were tested until a recent series of articles in the city’s newspaper raised parental anxiety and heightened pediatricians’ awareness.

“It’s amazing how many of them are coming up with abnormal test results,” Reigart said. He was interviewed as he waited at the hospital for the admission of the 28-month-old grandchild of a prominent surgeon in town, a baby girl who had been poisoned during the renovation of her home. Her blood lead that day had reached 60 micrograms per deciliter.

“Our experience has been that . . . in somewhere between 70% and 80% of people who do renovations without removing their children from the house, the children have elevated levels in their blood--higher when the family is doing the work themselves,” he said.

Many parents of children with learning disabilities now tell him they renovated old houses when the children were 1 or 2 years old. “They had vague symptoms that no one ever tied to the lead, and now they have learning problems,” Reigart said. “That’s what we are trying to prevent.”

The most tragic cases, of course, are bright youngsters who were mentally retarded after eating large amounts of lead, usually in paint chips. Physicians who have treated such children describe playful, alert toddlers who reached their developmental milestones on time--learning to walk, talk and interact normally--only to end up mentally impaired and in remedial classes at school.

Children Lose Skills

“You have no real feeling for just what a terrible thing this can be until you run into a mother or a grandmother taking care of a child and she said, ‘Oh yes, Johnny, he doesn’t tie his shoes anymore,’ and they call him in, and you are looking at a little kid who has been lead-poisoned,” said Jim Simpson, a public health adviser for the Centers for Disease Control who witnessed such a scene many years ago in New Orleans.

The prospects are brighter but still uncertain for Reina Rugerio, 3, of Long Beach, who was in danger of going into convulsions from lead poisoning two months ago. Bright-eyed with dark thick lashes and a ponytail, Reina betrayed no trace of illness while at home three weeks ago, skipping around the tidy living room, eating Popsicles and proudly showing off her necklaces.

She had been eating paint for several weeks, peeling it with her fingernails from a metal water heater closet in the back yard, before she was diagnosed with lead poisoning. Her mother said she tried many times to break Reina of eating paint, finally slapping the child across the mouth in desperation and even trying a paint chip herself to discover the appeal.

“It tasted like chalk,” Areli Maravilla, 23, an immigrant from El Salvador, said through an interpreter. “Reina liked the crunch of it.”

Symptoms Described

The girl developed severe nosebleeds, waking up in the mornings in a pool of blood with the sheets soaked. “I got very frightened because my daughter had always been very active and playful, and she wouldn’t eat and she wouldn’t play,” her mother recalled, sitting in their living room, filled with plants and plastic flowers and pictures of children. “It got to the point that she was afraid to go to bed at night.”

At first, anemia was diagnosed and only later lead poisoning. Reina was hospitalized in May for chelation therapy. Her lead level, however, rose again and she returned to the hospital last month.

“I definitely do worry about the long range but I don’t know for sure right now what could happen because they haven’t explained that much to me,” Maravilla said.

It is this uncertainty about the long-term consequences that haunts parents of lead victims.

“I would find myself asking, ‘Oh my God, is she acting more hyperactive than usual? Is that because of the lead? Is she having an attention deficit right now?’ ” said Minda Bernstein, 36, whose 21-month-old daughter, Zoe, was poisoned last summer. “I couldn’t help myself.”

Bernstein said she had to make herself come to terms with her fears. “I didn’t want to be asking every time she got a low grade on a math test, was it because of the lead? I finally made a conscious decision to try to lay it to rest, and with time, it is getting easier.”

Had Taken Precautions

A bright child with light blue eyes and dark blonde hair cut in a pixie, Zoe was poisoned when her parents, concerned about the peeling lead paint in their New York country home, tried to remove it for her safety. They were aware of the dangers of removal, and they took precautions to protect her.

Much of the woodwork was taken outside to be stripped, and the rest done on the second story of the 17-room house. The family remained isolated in two rooms that they thought they had sealed from the rest of the house. At the end of each day, the house was vacuumed thoroughly.

It was all futile. Vacuuming just spread the tiny lead particles: They escaped through the holes in the bag. On a rainy day, Zoe’s father, Harle Thomas, 40, accidentally tracked in a paint chip. Zoe ate part of it before her horrified parents could get it out of her mouth.

They called a poison-control center. Officials there told them not to worry about a single paint chip but to get Zoe tested eventually because of the paint-removal work in the house. Nearly three months after the work began, Zoe had a lead level of 37 micrograms per deciliter, and she was hospitalized for chelation. The dust, not the chip, was to blame.

Intelligence a Consolation

Bernstein said her only consolation is Zoe’s obvious intelligence. She is alert and talkative, successfully attempting such words as “condominium” and “curious,” and seems to be developing on target or even in advance of expectations. But no medical expert will tell Bernstein that her child has suffered no permanent damage, an assurance the mother “repeatedly wanted to hear,” and she has found no comfort in reading reams of scientific reports about lead in children.

Rosen, the professor of pediatrics at the Albert Einstein College of Medicine in New York, evaluated Zoe’s case and advised her parents on treatment.

“She has very supportive, interested parents, and if she has lost a couple of IQ points, her nurturing environment is a great compensation to fall back on,” said Rosen, an expert on diagnosing and treating lead intoxication. “So I am optimistic. Hopefully, she will be all right or, to the extent there is a loss of potential, it will be very minor for her.”

LEAD POISONINGS Estimates of the number of children in the U.S. under age 5 exposed to lead from various sources:

Leaded paint 12.0 million Dust/soil 5.9-11.7 million Leaded gasoline 5.6 million Water 2.5 million Smelters 0.23 million

Source: Agency for Toxic Substances and Disease Registry