Lead poisoning is the number one environmental disease affecting American children less than six years of age, according to the Centers for Disease Control and Prevention (CDC). An estimated 900,000 children ages one-to-five have blood lead levels at or above the level of concern established by the CDC. Lead exposure can cause irreversible harm to young children, babies, and fetuses. Adding to the concern, is the fact that most children with elevated blood lead levels do not have overt, easily identifiable symptoms.

Lead is a naturally occurring element that is highly toxic to humans of all ages when taken into the body through ingestion or inhalation. However, lead is most hazardous to young children, whose still-developing brains and nervous systems are particularly vulnerable to lead. Low levels of lead exposure in children can produce permanent nervous system damage, including reduction of intelligence and attention span, reading and learning disabilities, and behavior problems. Very high levels of lead exposure can cause mental retardation, coma, convulsions, and even death.

The good news is that lead poisoning is preventable, and childcare programs play an important role. Children most at risk of lead poisoning are those who live in homes or frequent places, such as childcare facilities, that were built before 1978. In 1978, the Consumer Product Safety Commission (CPSC) banned the sale and distribution of residential lead-based paint. Approximately 75 percent of the nation's housing stock built before 1978 (approximately 64 million dwellings) contain some lead-based paint. Many childcare facilities, both centers and home-based, may have lead-based paint.

The most common cause of childhood lead exposure is ingesting lead-contaminated dust. This dust may be created by deteriorating paint, contaminated soil, or renovation activities with improper removal of lead-based paint. The lead-contaminated dust then gets on children's hands and toys and into their bodies through normal hand-to-mouth activity. Also, children may eat lead-based paint chips from window sills, furniture, or walls with chipping, peeling, or flaking paint.

Children in childcare programs also may be exposed to lead through outdoor activities. Soil and dust in the play area may be contaminated by industrial emissions or by emissions from automobiles that still use leaded gasoline. Also, "front yard car repair" activities could contaminate yard soil.

Here is an example: A childcare program was housed in a renovated house built before 1978. This house was located directly behind a gas and service station. To make the situation even worse, the children's play area was below the ground level of the gas station, so all runoff from the gas station could easily enter the play area. Finally, there was a small drainage ditch along the edge of the play area that frequently held water and debris. As children played outside, they not only got potentially contaminated dirt on their hands, but also their toys and balls often landed in this ditch.

Drinking water is another potential source of lead exposure. Very little of our nation's water is lead-contaminated at the source but household drinking water can be contaminated by lead in the delivery system. Pipes, solder, and flux used in plumbing systems, and sink fixtures, may contain lead.

These three conditions-lead-based paint, soil and dust, and drinking water-are the major sources of lead exposure. However, lead also is present in many other products found in childcare programs. Some imported toys, color crayons, vinyl mini-blinds, ceramic dishes and pottery, and porcelain have been tested and found to have lead contents in varying amounts. In home-based childcare programs, children may be exposed to lead through the occupation or hobby of a family member such as pottery or stained glass making, re-loading ammunition, fishing, or furniture refinishing.

Prevention

Prevention of childhood lead poisoning begins with knowledge. The following is a list of what can be done if you suspect a lead hazard exists.

• Clean up paint chips immediately and keep surfaces painted with lead-free paint.
• Wash children's hands often, especially before they eat and before nap time and bedtime. Clean floors, window frames, window sills, and other surfaces daily using warm water and a general all-purpose household cleaner.
• Thoroughly rinse sponges and mop heads after using them to remove traces of lead dust.
• Keep play areas clean; wash bottles, pacifiers, toys, and stuffed animals regularly.
• Keep children from putting their mouths on window sills or other painted surfaces.
• If the playground or yard soil is possibly lead-contaminated, clean or remove shoes before entering the child care facility or home to avoid tracking in lead from the soil.
• Ensure children eat nutritious, low-fat meals high in iron and calcium; well-nourished children are at less risk of lead poisoning because their bodies excrete more lead than children with bad diets.

Facility renovation and maintenance

If you are opening a childcare program, renovating an existing facility, or expanding to a different facility, consider these points related to lead hazards:

Age of building. If the building was constructed before 1978, it is likely to have lead-based paint. Keep in mind that lead-based paint that is in good condition may not pose a health risk. Although proper maintenance of lead-based paint can be the least expensive method of preventing it from becoming a danger, in some cases even maintenance may not be enough. Lead-based paint on friction surfaces, such as on window frames and door frames, does break down into lead-contaminated dust. Lead-based paint on "mouthable" surfaces, those around which a child can place their mouth, may not be sufficiently protected with cover coats of unleaded paint. Children can still access the lead in lower layers of paint by biting and chewing on the mouthable surface.

If you are considering remodeling a facility with lead-based paint, be sure to do the activities in a safe manner. Call 800-424-LEAD and request a copy of pamphlet number 747-R-94-002 Reducing Lead Hazards When Remodeling Your Home. Please note that some state laws require that only trained professionals do lead abatement activities. Call your local health department for guidance.

Location of facility. Soil in areas close to roadways, car repair shops, or near businesses with lead-contaminated industrial emissions, may be lead-contaminated. Likewise, if the property houses or previously housed a business or other activity that is known to involve lead, such as gun and ammunition shops, the soil may be contaminated. If that soil is bare, children playing in the soil can be exposed to the lead. To reduce the threat of lead exposure, a thick carpet of grass or other ground covering plant should be maintained. If this is not possible, due to foot traffic and playing, the contaminated soil should be removed and replaced with "clean" dirt.

There are trained professionals who can test for lead hazards. Consider having such testing completed before opening a program if any of the risk factors exist. If you are unsure of the contents of the paint, soil, dust or water at your facility, consider having these tests performed.