We recently connected with Elizabeth Kelley, Lead Poisoning Prevention Clinical Lead at Neighborhood Family Practice and clinical lead of the Lead Safe Screening & Testing Program. This program is part of the broader work of the Lead Safe Cleveland Coalition.
Elizabeth shared thoughtful insights about development and health impacts as well as the importance of community advocacy. Her responses offer a deeper look at the work happening in our community to protect children and families.
Risk Assessment & Screening
What questions do you ask parents during well-child visits to assess lead exposure risk?
We ask: if their child spends more than ten hours each week in any house built before 1978 if they have moved recently, or if they’ve done any home remodeling in the last six months. We ask if any siblings have had an elevated lead level in the past.
Questions that identify behaviors or habits help to assess risk of exposure as well. We consider adult caregivers’ jobs or hobbies that may be a source of lead in the home. Whether the child frequently tries to eat things that are not food can identify additional risk. We talk about spices, cosmetics, and cookware used in the home that can contain lead.
Developmental & Health Impacts
What early signs of lead exposure or developmental changes should parents watch for?
Lead poisoning is a spectrum, and most cases are asymptomatic. No amount of lead in a child’s blood is safe: even low levels have an impact. A child with a blood lead level above 1.3 has twice the risk for ADHD, antisocial behavior, and a loss of 1-3 IQ points. As the level of lead in the body increases, so do the risks for developmental delay, learning disabilities, growth delay, and hearing problems. Lead poisoning symptoms include fatigue, cramps, vomiting, anemia, headaches, hyperactivity, or behavior changes. These are relatively common symptoms but recognizing them as potentially indicative of lead poisoning can be key in identifying at-risk children.
How do you communicate the long-term impacts of lead exposure to families in a clear, non-alarming way?
I share the long-term impacts of lead exposure but focus on the things that are within our control and emphasize the goal of preventing further lead absorption. We talk about being aware of what children are putting in their mouths, especially if they are eating things other than food. We recommend frequent hand washing and cleaning toys that are on the floor that children may put in their mouths. We provide cleaning education that focuses on where lead dust accumulates and encourage washing floors and windowsills with warm soapy water and rinsing with clean water. Simple things like leaving your shoes at the door when coming in from outside can help reduce lead exposure. We discuss letting the water run for a few minutes and using cold water to cook. Finally, we discuss taking a daily multivitamin with iron and eating a variety of healthy foods focusing on vitamin C, calcium, and iron to prevent further absorption of lead. Since we know that lead exposure can have lifelong impacts, our best defense is prevention.
Provider–Family Communication
What lead-related information do you believe parents most often misunderstand?
I think what is most misunderstood is that this is not an easy fix. Once a child has an elevated blood lead level, it requires frequent follow-up to track the blood lead level. Often it takes time for those levels to go down. Coordinating with the city or the county for home remediation is another enormous hurdle. Parents may not have the resources or the mental bandwidth to deal with landlords or city workers coming into the home to determine the source of exposure. Every step of this process is fraught with anxiety, frustration, and often red tape that is difficult to navigate. I think it is important to acknowledge that, and to express appreciation for all who work in this space with the goal of making homes safer for children.
How can community groups best support your work in educating families about lead poisoning prevention?
Community groups are a great support, providing education and awareness of the potential for lead exposure and the importance of lead testing. Billboards, TV/radio ads, and community events that engage families and provide free lead testing, resources, and support are essential in this work.
What have you found to be most effective in convincing expectant parents to take steps to prevent lead poisoning during early childhood?
One universal truth about parents is that they want the best for their children. Knowing that lead exposure can have a profound effect on a child’s growth and development, parents are eager to take steps to prevent lead exposure. I have found the most effective tool is engaging parents where they are. We establish a relationship based on trust and the knowledge that the health care provider also wants their child to have every opportunity for success in life.