How to look for signs of pediatric lead poisoning: ‘It’s kind of a silent contamination’

Lead exposure is often difficult to ascertain in childrenbecause it’s odorless and in many cases they don’t have outward symptoms, Northwestern Medicine pediatrician Kristina Stibitz says.

Editor’s note: This is Part 2 of a series by the Daily Chronicle looking into the water system in the city of Sycamore. Read Part 1 here.This project was made possible, in part, through a grant from the Fund for Investigative Journalism. This series is being made available to our readers for free. Please consider subscribing to help us continue the work we do on behalf of our communities.

SYCAMORE - Issues concerning Sycamore residents about potential lead exposure from their water hits home with Northwestern Medicine pediatrician Kristina Stibitz.

She grew up in Flint, Michigan. In medical school she trained under Dr. Mona Hanna-Attisha, whose collection of data from her patients brought the Flint water crisis and how it affected children into the national spotlight.

“For me personally as a doctor in training at the time, it was heartbreaking to witness how these social determinants of health — simply what ZIP code a child was born into and what drinking source a child received — could have a drastic impact on that child and their developmental future,” Stibitz said.

Since beginning her pediatric work in DeKalb County, she hasn’t personally treated any children experiencing lead poisoning. It doesn’t mean, however, that the issues aren’t serious or that parents’ shouldn’t watch for signs.

Stibitz said acute or prolonged lead exposure, especially in toddlers age 6 and under, can lead to cognitive impairments, hamper neurological development and cause longterm problems if not treated.

“You can’t smell it, you can’t tell how it looks, so it’s kind of a silent contamination,” Stibitz said. “We really can’t tell, our kids can’t tell us either most of the time if they don’t have outward symptoms.”

Greg Maurice, director of health protection at the DeKalb County Health Department, said the health department has been contacted by Sycamore residents regarding lead exposure amid ongoing water quality debates.

“We have seen a mix of high levels in the water sample and no lead level in the water samples,” Maurice said. “We have taken less than 10 samples for lead, but samples don’t need to be taken by the health department.”

It’s state agencies — the Illinois Department of Public Health and the Illinois Environmental Protection Agency — that regulate investigations surrounding lead poisoning when it comes to public water sources.

County health officials act as an educational advocate when someone’s child tests positive for lead poisoning or there is potential exposure, Maurice said.

“The health department is notified by the child’s physician if the child has an elevated blood lead level,” Maurice said. “We then contact the family and work with them.”

Maurice said health officials will monitor the health of the children and, depending on the level detected, also will evaluate the home for environmental sources of lead, whether on paint or cookware.

And what about water? Questions persist among Sycamore residents spurred by several homes in the city’s south side neighborhoods testing positive for elevated lead levels. As a result of those levels, the Illinois EPA has started to require water testing in the city every six months.

According to the US Centers for Disease Control and Prevention, the most common sources of lead in drinking water come from lead pipes, plumbing fixtures and faucets.

“Certain pipes that carry drinking water from the water source to the home may contain lead,” the CDC states. “Household plumbing fixtures, welding solder, and pipe fittings made prior to 1986 may also contain lead.”

Though federal laws were enacted over the past nearly four decades to require guidelines for regulating community water supplies, including the Safe Drinking Water Act in 1986 and 1996 and the 1991 US EPA’s Lead and Copper Rule, lead in water can still be prevalent. That includes in homes with lead services lines, according to the CDC.

Stibitz spoke with the Daily Chronicle to share what parents should know, signs to watch for and what to do if lead exposure is suspected:

Daily Chronicle: What are symptoms of potential lead exposure?

Kristina Stibitz: “In general for both children and adults, it’s really no symptoms. It’s almost silent in that sense and that is what is most troublesome.

“A lot of times we can have very subtle neurological changes based on chronic exposure that we don’t see, and that’s why we always have to do early screenings of elevated levels.”

DC: Beyond potential water exposure, what are some other places lead might be found?

KS: “Sometimes different toys can have hidden lead so we make sure parents are aware of toy recalls. Then there’s some other more unusual exposures, outdoor exposures from soil and dirt especially close to a factory where lead could be dropping into the soil. There are other kinds of specialty foods or canned foods from outside the country that may have lead in either the food cans or other traditional medicines or cosmetics that aren’t manufactured in the Unites States.

“You may not be updated outside, or maybe older housing that has the potential for lead contaminated paint and dust on the ground. If there’s renovation of those older homes, that increases dust particles that are on the ground where children are mostly playing. Other things of that nature, old lead corroded pipes can also be a risk.”

DC: What are lead screenings and when should they be done?

KS: “It is a routine screening, especially given the attention of the Flint, Michigan, water crisis. Generally around 12 months and 24 months at least we’ll administer lead screening for the parents to fill out if they have risk factors or not risk factors. If there are risk factors identified then we do blood screening tests. We start with a finger poke first, and if that’s elevated, we confirm with an official blood draw.

“Some children that are already high risk, we’ll test no matter what. Generally low income population [if they have older homes where housing units may not be up to code], patients who are on Medicare, and then certain ZIP codes.”

DC: If lead is detected in a child’s blood, what happens next?

KS: “It really depends on how high [the level is]. The gold standard is that vein blood draw which will tell us how much lead is in our system. If it’s acute lead exposure (not so common) it might lead to hospitalization and medical IV treatment called ketolation, which is when a binding agent is inserted which binds with iron in your blood to get rid of that lead.

“Most times [lead level in blood] is slightly elevated where we look to test at home where that source could be coming from. So testing from water, paint chips and trying to reduce those sources at home.”

DC: Should other people in the household get tested for lead if someone is confirmed to have been exposed?

KS: “It depends on how high that [first] test is. Maybe if it’s elevated in the child it may be recommended for their family to be tested. We get more concerned of children being exposed to lead because the point of life where they’re at with their neurological development. At least with adults, they have reduced maturity of their neurological development. It could [develop as] anemia in adults but affects children much more because they’re still having brain development.”

DC: What are the neurological side effects of lead exposure in children?

KS: “There are subtle chronic exposures if you’re having it in water in an old house. So what you’ll see is actually a change in our behavior, not able to focus as well as school and then our cognitive behavior, too. Having some learning disabilities, not able to focus on classes, not reaching our full potential.”

DC: What about babies?

KS: “They may have delayed milestones and development that you may notice, so it’s a little more subtle. They may also be sick with higher levels of lead, so vomiting, stomach aches, not feeding well, not gaining as much weight.”

DC: Can you speak a little more about treatment for exposure?

KS: “For severe cases [patients] get ketolation. Then we get poison control helping us. In the less severe cases it’s reaching out to our public health department to do testing of the environment around the home, trying to identify those sources of lead at home or if it’s the water, and reducing those exposures in hopes that we can repeat the test at a later time and see [the level] is trending down for the children.”

DC: What happens if lead poisoning goes untreated?

KS: “Having that risk of losing that full cognitive potential for kids, prolonged and increased learning disabilities, not able to reach our full potential later in life, having those long-term behavioral concerns, hyperactivity. Sometimes it can predispose us to worsening anemia, affect how our nutrition is for our body.”