Rule #1: Get your children screened for lead poisoning regularly. Not all doctors do this, so you need to take charge if it's not a regular feature of your children's pediatric exams. In some states, lead poisoning testing is mandated for the youngest children; federally, it's required for those in the Medicaid program. But compliance isn't always guaranteed.
If it were us (and it is), we'd spring for the screening at least for the first couple of years -- and after that if the family abode undergoes any renovation. (Oh, and don't relax just because your child tested fine as a 1-year-old. Research in Chicago showed that 21 percent of children tested at age 1 ended up with elevated BLLs during a later screening -- an "expected" result given the greater mobility, oral behaviors, and outdoor play typical of 2- and 3-year-olds.) Get the doctor to explain the results, but if it's above 5 micrograms per deciliter (half of the current "safe" level of 10 micrograms), we would strongly recommend finding and removing the source of lead exposure.
Rule #2: Evaluate the presence of high-risk conditions at home or anyplace where your child spends a substantial amount of time. The most effective way to reduce exposures to hazards is to make sure they don't exist or to eliminate them if they do. So, if your home predates 1978 (even if it's been updated in the interim) and has any peeling paint or other deteriorating surfaces, leaks, or rubbing doors or windows (or, heaven forbid, your child has elevated lead levels), you need to have your home evaluated for the potential and scope of any lead paint hazard.
Do not, do not, do not try and evaluate the situation through home testing. According to the EPA, home test kits are not reliable enough to give accurate readings. You need professional help.
Rule #3: Check the dirt. If your children play in areas where they're exposed to bare soil that is located near high-trafficked roads or older buildings with peeling paint, get the soil tested or keep your children away. Since the EPA does not find home tests to be reliable, we suggest you hire an EPA-certified professional to evaluate your soil if you have concerns.
And if it turns out you do have a problem? Besides making sure that toys and hands that spend time outside are cleaned often, you'll need to cover any bare soil with a thick barrier layer -- of mulch, sod, sand, whatever -- to raise ground levels. And, certainly, reconsider those plans to plant any vegetables or herbs there. Lead-laden soil is not exactly the best base for food that may hit your family's table.
Rule #4: Clean with a purpose. While there's some controversy about how much good cleaning can do if you have substantial lead dust in your home, in the absence of any conclusive results, we'll go with the suggested practices of just about every government agency we've looked at in this regard.
And look at it this way: Even if the effectiveness of all this elbow grease isn't completely clear as far as lead dust is concerned, at least you'll be helping to mitigate other dust-driven maladies like asthma, allergies, and unpleasant-looking furniture.
Rule #5: Watch your family's diet and hygiene. Just add lead protection to the list of reasons why your family should stay away from fat, which increases lead absorption, and eat nutritious meals -- especially ones with lots of calcium and iron, which can help to minimize the body's ability to absorb lead (within limits). Calcium, however, can also reduce the body's ability to absorb iron, so ask your pediatrician how much calcium your children should be getting each day.
On the hygiene front, if the threat of colds is not enough of a reason, then the threat of lead ingestion should hopefully convince you to get all your kids in the habit of washing their hands (and faces) often, especially before meals, naps, and bedtimes. Finally, this should be a given but, whatever you do, don't let your tot chew on windowsills, doors, or painted furniture surfaces.
Rule #6: Don't ignore the dangers of renovation. We only know of one person who even considered lead when she was renovating her apartment -- and we know tons of people who have made glorious apartments out of wrecks. We're better informed now. If you're renovating a pre-1978 home, follow approved procedures for conducting the work. Both the EPA and your local health department provide guidelines, but essentially anything that disturbs a lead-painted surface -- like drilling, nailing, wall demolition, making holes for pipes or electrical wire or cable, scraping or sanding, etc. -- can create a major problem.
If you're in a potential lead-paint hazard area, there are steps you must follow that cover everything from sealing off work areas while the work's being done (ideally, keeping kids out of the home while the work's in progress) to covering furniture to cleaning up after it's all over. Just make sure that you and your contractor agree on what needs to be done and follow the rules religiously. And if you really want some peace of mind, think about having a hazard assessment done after you've finished it all and before the kids are back home.
Rule #7: Make everybody take their shoes off before entering the home. This may be just about one of our favorite rules. It's possibly the most helpful way of keeping lead from outside dirt from entering your home -- and, oh yeah, it keeps the dirt out, too.
Rule #8: Watch out for the H2O. Minimize your child's exposure to other potential sources of lead, like water. It's generally only a problem if lead is leaching into cooking or drinking water via old pipes made with lead or lead fittings (such as those that exist in many prewar buildings), and it is a particular issue with hot water. The easiest way to control this is to limit your water use for cooking or drinking to the cold water tap.
As a safety mechanism, run it for a minute first -- well, at least 30 seconds, if you can't be that disciplined. The only problem with this is that "flushing" the pipes isn't always effective in high-rise buildings, which may have large-diameter supply pipes. If you are concerned, get the water tested. In some cities, New York for one, the Department of Environmental Protection will test your building for free. In less-generous cities, you should be able to get it done for about $50 or so (but beware of getting services from any testing group that may have a vested interest in how your results come in).
Rule #9: Never ignore the problem. If, by any chance, it is determined that lead hazards exist in your home, they must be taken care of. Views on the proper handling of lead paint vary, particularly whether abatement (permanent elimination of hazards) is preferable to interim control (treatments that temporarily reduce the risk of a hazard, like repairing chipped paint surfaces). Procedures are complicated. This is not a do-it-yourself job, and anyone you hire should be EPA-certified. Don't mess around: Get help from your pediatrician, your city health or environmental department, and the EPA if need be.
Excerpted from The City Parent Handbook: The Complete Guide to the Ups and Downs and Ins and Outs of Raising Young Kids in the City (Rodale, 2004) by Kathy Bishop and Julia Whitehead. Both women live, and parent, in New York City.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.