When parents read with little ones, they often choose timeless favorites, including books such as “Good Night Moon,” “The Hungry Caterpillar” or “The Velveteen Rabbit.”
Now, a non-fiction title is poised to join the list: “Happy, Healthy, Lead-Free Me!” by Gail Gettens and Knatalie Vetter, public health and environmental safety educators at the New Hampshire’s Division of Public Health Services – who created the book to inform families of an invisible peril that may exist at home, where it’s under-estimated or ignored.
The problem likely affected untold numbers of children who sheltered in place in older homes during COVID, when school and life became remote, and many parents undertook do-it-yourself improvement projects, unaware of the potential risks.
Lead paint poisoning is not a topic that many people talk about or necessarily even think about. Most families consider it rare misfortune, a bygone issue or something that happened somewhere once to someone else’s kid.
“There’s a false sense of security. There’s a huge knowledge gap in and around lead and lead hazards in the home,” said Gettens, who is a child development specialists and health promotion advisor. “Lead is the under- the-radar stealth poison” — and the threat persists today.
New Hampshire has some of the country’s oldest homes, and many still contain lead paint. On average, 55% of housing statewide was built before lead-based residential paint was banned in 1978, and the number is as high as 83% in some industrial-era communities across the state, according to Vetter, an environmental supervisor of the state’s Healthy Homes and Lead Prevention Program. It’s common in former mill cities and towns such as Franklin, Laconia, Tilton, Dover, Manchester, Nashua and Claremont.
According to data from NH–DPHS, roughly 50% of New Hampshire children age three and younger currently live in housing built before 1978.
The state’s lead poisoning rate hovers at roughly twice the national average, according to a 2019 report by New Hampshire Listens, a research project of the University of New Hampshire’s Carsey School of Public Policy. Each year, approximately 600 New Hampshire children are diagnosed with levels of lead that surpass amounts found in 97.5% of American children, according to data from the New Hampshire Department of Health and Human Services.
Lead paint may lie under more recent layers of latex. It may be the dust that settles on windowsills, pacifiers, toys and on floors where children play and crawl. It’s released by the activities of daily life, such as furniture scraping on painted floors, and windows opening and closing.
“The misinformation is that children have to eat paint chips the size of potato chips. That’s really a myth,” Getten said. “The amount that will poison a child and impact them for the rest of their lives is so tiny you won’t see it. The only way you can know if you child has too much lead in their body that’s damaging their brain is by testing.”
COVID-19 cut down on lead screening
When it comes to lead poisoning, COVID created the perfect storm: testing dropped when routine children’s checkups were delayed or suspended during 2020’s shutdowns, and do-it-yourself repairs and renovations peaked while families were at home and handy parents finally had time. The Department of Health and Human Services is currently helping parents and children whose lead levels spiked to worrisome markers because of home improvement projects, instead of testing the paint first and hiring a lead-certified contractor if needed.
“During the initial shut down, people were doing their own remodeling, without necessary information on lead,” said Kate Bruchacova, community educator from the Partnership for Public Health, Winnipesaukee Region.
In addition, families traded homes in cities and suburbs for the fresh air, open space and relative safety of the Granite State, and the housing supply tightened including in small towns and in rural, vacation areas. The actual amount of children and pregnant women affected remains unknown.
“I’m sure there are people who bought old homes and are doing their best to fix it up themselves,” Bruchacova said.
While nearly everyone was isolated at home, most doctor’s offices closed to in-person visits other than for emergencies or serious chronic conditions, and routine child testing and vaccination rates plummeted, according to health officials.
In 2020, 3,108 fewer New Hampshire children were tested for lead than in 2019 – a 14% drop, according to data reported to the NH Department of Health and Human Service. That’s a significant number in a small state, Gettens said.
Adding to the missed well-child checkups, a recall of the skin-prick tests supplied to doctor’s offices between August 2021 and Feruary 2022 put a lid on lead screening at ages one and two, the ages required in New Hampshire, and the stages where children are crawling and playing on the floor and putting things in their mouths.
Up to that point, approximately 75% of the state’s pediatric practices employed the office finger stick test, which provided near-instant readings of lead levels in blood while parents and children waited. In-office testing resumed in March and April at some New Hampshire practices. But there are still widespread supply chain delays, and many providers don’t have kits. Families are sent to outside labs, which requires a separate visit and wait – an alternative that has much less follow-through, according to doctors and health officials.
A question looms: How big is the lead paint poisoning problem for children today?
A lingering mindset gets in the way
There’s still a culture of ignorance and denial when it comes to the dangers of lead, health educators said. Frequent cleaning of areas where children live and play, and washing hands religiously before eating became habits for adults during the pandemic, yet such habits don’t always stick. The hygiene that also reduces lead poisoning risk may be ebbing now, especially for children.
“For most parents, it’s not a big concern,” said Dr. Maude Aldridge at Concord Hospital Laconia – Pediatric Care in Belmont, who encourages preventative hand and surface washing. “Some know there’s lead in the home. But until you test a child you’re not aware. You don’t see lead exposure. You don’t see them ingest it. And you can’t undo the exposure.”
There is no uniform or predictable level at which irreversible damage from lead occurs. That makes the problem murkier, and a harder sell among skeptics. Children’s systems differ, along with their ability to purge toxins, according to medical experts. Damage can occur from a relatively small amount, or exposure that builds over time, or a single overwhelming event. Elevated lead beyond what an individual can tolerate can cause lasting brain and behavioral damage that may not be discernible until a child is older and learning to read and interact.
For decades, medical research has tracked the issues associated with elevated lead levels in children, including attention deficit disorder, learning delays, and speech and language and hearing problems.
“Are they related to lead exposure, or would they have happened in a child anyway through experience or genetics? We know it’s a risk factor with all these issues,” including behavior and developmental disabilities. “It’s important for parents to pay attention and get their children tested because it’s one risk actor that can be controlled,” Aldridge said.
“Lead poisoning is one of the few preventable causes of brain damage,” said Dr. Christine Arsnow of Concord Pediatrics, vice president of the New Hampshire Chapter of the American Academy of Pediatrics. “It’s preventable when detected early,” and that makes early testing essential.
Testing is important for every child, she said, “because we’re not in a bubble. Even if your house was built recently, what about the day care?” Or the other places children spend time, including grandparents’ and friends’ homes and houses of worship that were built 50 years ago or much earlier.
In some communities, the pandemic’s testing decline was egregious, and the numbers have yet to recover.
Dr. Michael Matos at Wolfeboro Pediatrics said his office witnessed a 95% drop in lead testing when in-person visits slowed to a trickle in 2020. Now his office is waiting for shipments of in-office test kits, after returning a recalled batch. The nationwide recall was eventually found to be related to chemical off-gassing of the cardboard packaging, not flaws in the testing apparatus itself, according to health officials.
“We haven’t gotten the supply back. We’re sending parents to the lab,” Mantos said. Whether the testing gets done now, “depends on how important (parents) think it is and whether they have the time.”
Lead poisoning continues to be perceived by many as a sleepy or non-existent danger, and it’s overshadowed by more apparent and immediate COVID-world concerns, including vaccination. And parents never know it’s happening.
“You really don’t notice any changes until children aren’t learning or acting correctly. They can get hyperactive with lead poisoning,” Matos said. In the shorter term, it can cause abdominal pain and appetite loss – symptoms that can be mistaken for something else “that parents can’t seem to put a finger on.”
Matos said it’s crucial that children get tested at ages one and two, in compliance with state guidelines. “You try to get a baseline before they’re up on their feet a lot. This is a time when everything goes from their hands to their mouths. What’s in their environment is going to affect them, and what you’re dealing with at that point is brain development.”
A board book to spark public interest and action
Public health authorities and pediatric care providers hope the board book, which is passed to parents at their child’s 9-month and 1-year checkups and whenever providers can send it home, will jumpstart awareness and response.
So far 13,000 copies of the book have been distributed, and orders have come from public health officials in states as far as Idaho and Hawaii. Toledo, Ohio’s public health department ordered 5,000 to 6,000 copies, said Gettens, who recently gave a reading of “Happy, Healthy Lead-Free Me!” at the Gilford Public Library.
Between November and March, Caroly Stone, a community outreach worker for Lakes Region Community Services, distributed roughly 700 copies to libraries, childcare centers, Aspire for Women, Healthy Families, Head Start and Community Action Program, Belknap-Merrimack Counties. The book will soon be circulated through the Welcome Baby home visiting program, she said.
Stone, who recently moved from New Jersey, said she was surprised to learn, like many others, that lead paid poisoning exists here and now.
Health officials say the risk is universal.
“Living anywhere in the Northeast, we’ve had so much lead in our paint for years and years, it’s still in the environment,” Matos said. Once elevated levels of lead are detected, “the damage is done. At that point you’re mitigating further exposure.”
He cites a lead-era building in Wolfeboro, next to an elementary school and a short walk from a childcare center, that was renovated without any containment of dust and debris. Children walked by it every day, he said. Were they affected?
“People never think it’s in the soil” – another frequently overlooked source, said Matos. Like so many toxic substances, “It doesn’t sting. It doesn’t burn. If you’re working on it, you don’t know it’s there.”
“I know the book is valuable if it reaches one family and gets them to take their child for lead testing,” said Stone.
“I learned a few things,” said Sarah Morgan of Wolfeboro, who read the book before it was published as a parent and board member of the Wolfeboro Children’s Center. “Lead is not something a lot of people talk about, especially now. The book is written for parents and children alike,” she said. “It’s family friendly, even for young kids to read to their younger siblings. They asked questions. Lead can be scary. This is a friendly way of doing it, especially if you’re a parent who may not know.”
Health care providers and agencies interested in ordering free copies of “Happy, Healthy, Lead-Free Me!” can email [email protected] or download a free copy, which is available in seven languages, at happyhealthyleadfree.me.