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By Dr. Lakshman Abeyagunawardene , MBBS., MD., MPH

Lead is a metal that has no known value to the human body. On the other hand, its poisonous effects are harmful especially to children whose growing bodies are more sensitive, and also they process lead differently from adults. Younger children in particular tend to have more hand to mouth activity, and they absorb more lead than adults from what has been taken in along with food and non-food items. Being an extremely useful metal in other respects, lead is still widely used in industry.

By banning the use of lead in paint and gasoline (petrol), food industry not using lead soldered cans, etc; the US Federal Government has taken many steps in recent times to reduce the amount of lead in the environment. However, lead being able to withstand extremes of temperature and any kind of weather, residual lead continues to pose a threat to the health of children.

Childhood lead poisoning is still a major preventable environmental health problem in the United States with over 890,000 children with elevated blood lead levels according to current estimates. Childhood lead poisoning prevention programs nationwide are being funded by the Federal Government through the Centers for Disease Control and Prevention (CDC). A high powered Presidential Task Force has set year 2010 as the target date for the elimination of childhood lead poisoning.

If that is the current situation in the United States which has given such high priority to this problem , it can very well be imagined how serious the problem could be in a poor developing country like Sri Lanka. In that context, the decision taken by the government to ban leaded petrol in Sri Lanka even at this late stage is most welcome. As it is unlikely that lead in petrol is the only source of lead exposure, the availability and use of unleaded petrol alone will not prevent more and more children falling victim to lead poisoning. But nevertheless, when the government is taking such a major policy decision as banning the sale of leaded petrol, it is also an opportune moment to create public awareness on the problem of childhood lead poisoning, which is the main intent of this article.

Harmful effects of lead

It does not take much lead to poison a child. Even though there may not be any obvious symptoms when the amount of lead in the child's blood is small, it may still cause severe permanent damage to the body. The only way to know whether a child is poisoned is by doing a blood test. At higher levels of lead in blood, it may cause a variety of symptoms such as loss of appetite, stomachache, constipation, and vomiting. The child may be excessively tired, cranky, hyperactive, or lose interest in playing.

Lead poisoning may also reduce intelligence and attention span thereby significantly lowering the educational performance of the child. It may also cause reading and learning disabilities, loss of hearing, and delay a child's standing, walking and talking. At very high levels of lead in blood, the child may develop convulsions, become unconscious and even death may occur if untreated.

Sources of lead The sources named here are those commonly found in the United States. Without researching the subject further, it is not prudent to say here that all these sources are common to Sri Lanka as well.

Lead-based paint and dust, and soil contaminated with lead from petrol are the major sources of lead exposure in children. If lead-based paint in houses peels off or becomes flaky or chalky, it will form a fine dust. Touching this dust and then putting their fingers in their mouths may poison children, or they may even eat paint chips. Children may also chew on toys, furniture, windowsills, etc. which have been painted with lead-based paint.

Lead can also get into drinking water from lead pipes and solder in older homes. Some vinyl mini-blinds, lead-glazed ceramic ware, lead crystal, car batteries, bullets, fishing weights etc. are other less common sources of lead. Parents who work in lead related industries or have a lead-based hobby, might accidentally bring home lead dust on their clothes. This lead dust may also poison children in such households.

How lead gets into the body

Most commonly, a child gets poisoned when lead is absorbed from the intestines after it gets there along with food and beverages, or when a child takes in contaminated dust and soil through the mouth. Especially younger children have the habit of putting their hands and other objects into their mouths. More rarely, a child can also inhale lead dust and particles. An unborn baby in its mother's womb can get poisoned if the mother has been exposed to lead, and the level of lead in her blood is high. Lead can pass from the mother to the unborn baby through the umbilical cord.

Lead testing

As mentioned earlier, lead poisoning does not always produce obvious symptoms. The only way to detect it is through a blood test. In the United States, children are almost routinely tested for lead at 12 and 24 months.

Conclusion

As mentioned before, what is intended in this article is to create public awareness on the problem of childhood lead poisoning and not "lead education" as such. Lead education or health education to prevent childhood lead poisoning should be undertaken only if it is established through scientific studies that the problem does exist in Sri Lanka.

However, whether the problem exists or not, it is not a bad idea for parents to adopt a few practices that would protect their children from many other illnesses and not necessarily from lead poisoning. Proper hand washing before meals and after playing are very important practices that children should be taught to follow. As good nutrition is also important in preventing many illnesses including childhood lead poisoning, children should be offered three nutritious meals and two to three healthy snacks every day. Less lead is absorbed when a child's stomach is full. Children should be served with foods with a high content of iron, calcium and vitamin C. Adequate intake of these nutrients also minimize lead absorption.

As most of the harmful effects of lead poisoning cause permanent damage and because treatment options are limited, it is best that lead poisoning is prevented before it occurs. Lead poisoning of children is entirely preventable.

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