Over the past eight months, I’ve spent a mind-boggling amount of time and money trying to keep an invisible poison at bay. It started at my daughter’s 12-month checkup, when her pediatrician told me she had a concerning amount of lead in her blood. The pediatrician explained that, at high levels, lead can irreversibly damage children’s nervous system, brain, and other organs, and that, at lower levels, it’s associated with learning disabilities, behavior problems, and other developmental delays. On the drive home, I looked at my baby in her car seat and cried.
The pediatrician told me that we needed to get my daughter’s lead level down. But when I began to try to find out where it was coming from, I learned that lead can be found in any number of places: baby food, house paint, breast milk, toys, cumin powder. And it’s potent. A small amount of lead dust—equal to one sweetener packet—would make an entire football field “hazardous” by the EPA’s standards.
My husband and I spent nearly $12,000 removing highly contaminated soil from our backyard, replacing old windows, and sealing an old claw-foot bathtub. We mopped the floors at night, obsessively washed our daughter’s hands, and made sure to feed her plenty of iron, calcium, and vitamin C, which are thought to help limit the body’s absorption of lead. Four months later, when we went back to the pediatrician, her lead levels had sunk from 3.9 micrograms per deciliter of blood to 2.2 mcg/dL. That was better, but still far from zero. And according to the CDC, the World Health Organization, and the Mayo Clinic, zero is the only safe amount of lead.
We’re one of thousands of families who have gone through that ordeal this year. At least 300,000 American children have blood lead levels above 3.5 mcg/dL, the CDC’s so-called reference value. But parents are largely left on their own to get lead out of their kids’ lives. Families who can afford an abundance of caution can sink tens of thousands of dollars into the project. And they still might never hit zero.
When Suz Garrett learned that her 1-year-old son, Orrin, had four micrograms of lead in every deciliter of his blood, she and her husband waited for guidance from their doctor or the county health department, but none came. So they sent Orrin to stay with family while they repainted their 19th-century Richmond, Virginia, house and covered the open soil with mulch. Band-Aids like these are cost-effective, but every time you pry open an old window, or your dog tracks in dirt from the neighbors’ yard, invisible specks of lead dust can build up again.
For nearly a year, the Garretts cleaned religiously. Orrin’s blood levels are still detectable—currently, he’s at 2.1 mcg/dL. Garrett and her husband are fed up. In a few months they’re moving to a new house, one they took out a $200,000 construction loan to renovate. “We ended up gutting it so we would know there’s no lead paint,” Garrett said.
A few years ago, children like Orrin Garrett and my daughter wouldn’t have been a cause for concern. Until 2012, children were identified as having a blood lead “level of concern” at 10 mcg/dL or more. But for the past decade, the CDC has used a reference value to identify children who have more lead in their blood than most others. The reference number is based on statistics, not health outcomes. When most children tested below 5 mcg/dL, the reference level was five. Today, it is 3.5.
The reference level has trended down along with lead exposure, which has dropped by 95 percent since the 1970s thanks to policies that removed lead from gasoline, paint, plumbing, and food. But confusion and concern about what classifies as lead poisoning has risen.
Scientists and public-health officials still can’t say exactly how low lead exposure needs to be to prevent damage for any individual child. When Kim Dietrich, an epidemiologist and a developmental neuropsychologist, started his career in the ’70s, the general consensus was that levels above 40 to 60 micrograms took a significant toll on the developing brain. But work by Dietrich and others showed that harm can be caused at much lower levels. In the early 2000s, pooled data from seven large studies from around the world, including one Dietrich conducted in Cincinnati, showed that an increase in children’s blood-lead concentration from 2.4 to just 10 mcg/dL corresponded with a four-point drop in their IQ. That’s a scary prospect. But, Dietrich told me, “it’s very important not to confuse findings from these large population-level studies with individual impacts.”
Discerning the effect of low lead levels—below about 10 mcg/dL—on cognitive health is an extremely complicated issue. “If you’ve got a blood alcohol content of 0.2, you’re likely to be horribly dangerous behind the wheel no matter who you are. Lead is a little bit different. Your child’s two might be worse than my child’s 10,” Gabriel Filippelli, a biogeochemist who studies lead exposure in urban environments, told me. Part of the variation in outcomes could be the result of factors we still don’t understand, like a child’s genetic makeup.
Policing low levels of lead exposure in children costs parents both financially and emotionally. Mary Jean Brown, the former chief of the CDC’s Healthy Homes and Lead Poisoning Prevention Program, told me that concerned parents should be careful not to create a self-fulfilling prophecy. “Most children will not exhibit any symptoms when they have blood levels of 5 or 10 micrograms per deciliter,” she told me. But “if the mother or someone else says, ‘Johnny’s not like everybody else,’ pretty soon, Johnny isn’t like everybody else.”
This type of anxiety is familiar to Tanisha Bowman, a health-care worker in Pittsburgh who has spent nearly three years trying to lower her daughter’s blood lead levels. They initially peaked at 20 mcg/dL, and have ranged from two to six over the past year. “There was never anything wrong with her. She was always measuring four to six months ahead,” Bowman said. But it was impossible not to read scary headlines about lead and assume they applied to her daughter. When she had tantrums around the age of 2, Bowman started wondering if she had ADHD, which is sometimes associated with lead exposure. “I will never know what impact, if any, this had on her. And nobody will ever be able to tell me,” she said. (Bowman’s daughter has had no diagnosis related to lead.)
In the absence of a specific, outcome-based number to help parents decide when to worry, a mantra has emerged among doctors, reporters, and health institutions: There is no safe level of lead. Filippelli said that he’s used the catchphrase, but it’s a bit misleading. “There is no valid research source to support the ‘No amount of lead exposure is safe’ idea, beyond that fact that to avoid the potential of harm, you should avoid exposure,” he explained in an email.
As well intentioned as the guidance might be, avoiding all exposure is an impossible quest. Tricia Gasek, a mother of three who lives in New Jersey, tried desperately to locate the source of lead in her children’s blood. She spent $1,000 hiring a “lead detective” to test her home with an XRF device and getting consultations with experts, plus another $600 replacing leaded lights on the front door. Ultimately, she learned that she also had elevated levels and concluded that the lead in her son’s blood was coming from her breast milk—possibly, her doctors thought, from exposure she had as a child. The process was exhausting. “It’s just crazy. Why am I the one figuring all this out?” she says.
Parents simply can’t get to zero without help. Lead is invisible and pervasive. Although the Flint, Michigan, water crisis and recent product recalls have raised awareness about lead leaching from corroding pipes and hiding inside baby food, the biggest sources of exposure for children are the spaces where they live and play: inside houses and apartments with old, degrading paint and yards with contaminated soil. For many, there is no easy escape. Lead contamination is most common in low-income neighborhoods, which means Black and Hispanic kids are disproportionately affected.
Many local health departments, including the one where I live, offer home visits to help identify sources of lead, but in many cases only when levels are above 10 mcg/dL. So the majority of children with elevated lead levels receive little or no assistance at all, and families have to play detective, social worker, and home remodeler all at once.
This is paradoxical, because the problem of low-level lead exposure cannot be solved by focusing on one child or one home at a time. My family’s efforts helped lower our daughter’s lead levels slightly, but they did nothing to address the more widespread problem of lead in our neighborhood, to which she and all the other children nearby are still exposed. Instead of having every lead-exposed family play whack-a-mole in their own home, Filippelli says that if he were appointed czar of lead, he would do a national analysis of high-risk neighborhoods and households, perform targeted testing to confirm hazards, and remediate at scale. There would have to be coordination between the Department of Housing and Urban Development and the Environmental Protection Agency, and such programs could cost up to $1 trillion and take a decade. But, he says, we could significantly reduce lead exposure across the board. The trickle-down effects of half a million children becoming smarter, healthier adults would reach everyone, even if we can’t say exactly how much smarter or healthier they’d be.
For now, my family is still navigating this maze on our own. I’m trying to think of low-level lead exposure as a risk factor—like air pollution and forever chemicals—instead of a diagnosis. Meanwhile, my daughter is doing just fine. As a family, we’ll continue to avoid what lead we can; we’ve decided to spend a whopping $25,000 to repaint the chipping exterior of our house. But we’re still going to let our kid play at the park and climb the walls. After all, there’s no stopping her.