Leading on lead intervention

By Sarah McKenzie
Kyle plays with a truck in his home in the East Phillips neighborhood.

A spotlight on the City’s efforts to address childhood lead poisoning 

Kyle was drawn to peeling paint chips in his home like pieces of candy.

Even after Michelle Anderson, a City of Minneapolis health inspector, worked with his grandmother Stephanie and the family’s landlord to remove lead paint from their home in the East Phillips neighborhood, the toddler headed over to the duplex next door and found more flaking lead-based paint to chew on, enticed by its sweet flavor.

On Anderson’s urging, the family’s landlord, who also owns the neighboring duplex, started renovating that property and re-sodded the front lawn to remove the lead.

Kyle, 2, was one of 150 children with elevated blood lead levels reported to the City of Minneapolis in 2016 as part of its Healthy Homes & Lead Hazard Control program. The work Anderson and her Health Department colleagues do is critical to the future of these young children who face a wide range of health and behavioral problems as a result of their lead exposure.

The work is also a key component of Mayor Betsy Hodges’ Cradle to K Cabinet, which focuses on eliminating disparities among children in Minneapolis, prenatally to age 3. The focus is on ensuring all children have a healthy start, stable housing and access to high-quality, child development-centered child care and early education.

In Minneapolis, lead exposure is a widespread problem across the city since about 80 percent of the housing stock was built before 1978 when lead-based residential paint was banned. Low-income children of color are disproportionately impacted by lead poisoning in the city.

Lead dust is the main source of lead exposure among children, according to the Minnesota Department of Health. Opening and closing windows painted with lead-based paint is a major source of the lead dust. Some imported candies, toys, pottery and ceramics can also contain lead. 

For the past two years, the City had roughly 150 elevated blood-lead cases referred to its program each year, said Alexander Vollmer, supervisor of the Healthy Homes & Lead Hazard Control program.

Chipping lead paint and lead dust from a window sill are common sources of lead exposure for children.

The Minnesota Department of Health refers cases to the City of Minneapolis if a child’s blood lead level is greater than 5 micrograms per deciliter. The Centers for Disease Control considers that to be an “elevated blood lead level” or lead poisoning. Children under the age of 6 should be tested annually for lead.

As a result of collaboration between health professionals and government, spearheaded by Minneapolis, the State of Minnesota changed the definition of an elevated blood lead level from 10 to 5 micrograms of lead per deciliter of blood in 2014. This allows Minneapolis to perform full risk assessment/paint inspections and issue corrective orders to remove lead hazards in a poisoned child’s home. The mandatory level for inspections is 15 micrograms of lead per deciliter of blood, but Minneapolis chooses to be more protective and enforce at the lower level because the City has committed the resources to do so.

During Mayor Hodges’ tenure, the inspections of homes of children impacted by lead poisoning tripled between 2014 and 2015. Lead mitigation of homes also increased from 125 in 2014 to 164 in 2015. One hundred children have also been referred to educational support services, according to statistics provided by the Mayor’s office.

“It is our job to protect our most vulnerable children, and very young children are the most prone to lead poisoning because they actively explore their environment through taste and touch,” Hodges said. “That’s why it’s critically important that the City has invested in this work and increased outreach to parents and young children impacted. Early intervention is essential in making sure these children have the resources they need to be ready for school and success in life. We also know that addressing the housing conditions in Minneapolis is a key component of reducing the risk of lead poisoning and other health problems.”

Mikkel Beckmen, housing coordinator for Hennepin County and co-chair of Mayor Hodges’ Cradle to K Cabinet, said an emerging focus for the cabinet is improving the condition of housing in Minneapolis to address lead and other environmental issues that can lead to health problems for children.

“Under Mayor Hodges’ leadership with the Cradle to K Cabinet, there is a growing awareness that housing stability is a platform for success in every aspect of a person’s life,” he said.

A recent study by Case Western University’s Center on Urban Poverty and Community Development found that children living in poor quality housing in Cleveland were more likely to perform worse on kindergarten-readiness tests than peers in higher quality housing.

The study tracked the housing histories of more than 13,000 children entering kindergarten in 2007-2010 in Cleveland. Nearly 40 percent of the children about to start kindergarten tested above the public health threshold for lead exposure. It noted that several studies have shown that young children with elevated blood lead levels consistently score lower on school readiness tests and other developmental assessments compared to other children.

The researchers involved in the study recommended the city create a way to better track homes with lead hazards—information that doctors could share with parents to better understand the risks to their children.

While the crisis in Flint, Michigan over lead tainted water has turned more attention to the threat of lead in drinking water, lead in residential paint remains the most common source of lead poisoning.

The City’s Health Department recently submitted a grant application to the U.S. Department of Housing and Urban Development (HUD) for $2.9 million for a three-year period to provide lead remediation and healthy home services for up to 280 homes of low-income residents. The program includes a requirement of 10 percent of matching funds from the City and property owners receiving the grant funds.

Since 1997, the City has tapped the HUD grants to make 2,674 homes in Minneapolis lead safe for children.

A roller coaster ride

Like most 2 year olds, Kyle is transfixed by his toys. He is tall for his age and has a playful charm. These days, he’stalking more and has mellowed out considerably compared to when Anderson first started working with him.

Kyle had one of the highest blood lead levels of any children the City of Minneapolis worked with in 2016 when Anderson first got his case in February. Most children ingest lead dust by accident, by touching surfaces in their homes and then putting fingers in their mouths. Kyle was actively seeking out and eating paint chips because they have a slightly sweet taste.

Once the Minnesota Department of Health refers a case to the city, the first step is to go out and do a risk assessment at the child’s house. Anderson is typically joined by two paint inspectors who test all the painted surfaces in the house and toys for lead with an XRF Analyzer, which can determine the lead content of the paint in seconds.

The inspectors also collect wipe samples for lead dust from the floors and windows. The owner of the property then receives a risk assessment within 30 days, which includes orders to correct any lead hazard issues within 60 days. The City meets onsite with the property owners to go over the correction orders. Property owners either choose to pay for the repairs on their own or enroll in one of the HUD grant programs. For the final step, the City conducts a clearance inspection to determine if the lead hazards have been mitigated and it’s safe for the household to return to the property.

Anderson also interviews the parents during the risk assessment to get an in-depth look at how the child spends their time and to determine whether the family qualifies for a grant program to help cover the cost of renovations to make the house lead safe.

After Anderson and the paint inspectors visited Kyle’s home, she reached out to the family’s landlord who was eager to make the repairs necessary to remove the lead paint hazards.

The family moved into a City-owned duplex during the week when the contractor was making the repairs.

About a week after Kyle and Stephanie returned to their place, Kyle’s blood lead levels were again elevated. Anderson came out to inspect the property again and discovered that Kyle had pried off a piece of paneling which had exposed lead paint that Kyle was picking at and eating. The contractor arrived 15 minutes later and promptly fixed the issue.

The landlord later made fixes to the neighboring duplex after Anderson discovered Kyle had wandered over and found more lead paint to eat.

Anderson has also helped the family deal with bed bugs that invaded the house after they purchased a mattress from a hotel. As part of the Healthy Homes program, the City also provided the family a Pack ‘n Play, baby gates, outlet covers and smoke detectors, among other things.

Stephanie said she’s hopeful about Kyle’s future and eager for him to get a good education. There is also a push to get him into Early Head Start, which provides early education for children up to age 3.

As for advice for other caregivers of children, she urged everyone to be aware of a child’s surroundings and if they are putting items not intended for children in their mouths. If a product was not made specifically for children it may contain lead. Arranging the furniture so they can’t reach a window sill or places where paint is peeling can help.

Anderson said she has been an awe of Stephanie’s strength and resolve in making sure Kyle gets all the care he needs. His blood-lead levels have been on a roller coaster, going up and down over the past year.

The role of nutrition

Amy Waller, a public health nurse with MVNA, the community connections care division for Hennepin County Medical Center, works with Anderson and other Minneapolis lead inspectors on child lead poisoning cases in the city, including Kyle’s.

“Number one I try to make sure the parents understand the diagnosis,” she said. “Many of the people I see don’t understand the ramifications and possible risks. It can effect brain development and it can happen years later, which is the tricky part because most of the time when children are diagnosed they have no signs or symptoms.”

Waller spends a lot of time with parents of children with elevated lead levels to explain the seriousness of the problem and the scope of what needs to be done to get the levels down as fast as possible. Lead poisoning can lead to learning, behavior and other health problems for young children, and can impact their health as an adult.

“The problem is once the level is elevated, they are already at risk for problems,” Waller said.

A nutritious, well-balanced diet can help fight lead in the body. Foods high in fat, sugar and oils allow the body to absorb lead, while eating foods high in iron, calcium and vitamin C can help the body absorb less lead.

While the number of children with elevated blood lead levels getting attention is on the rise, Anderson and Waller see more opportunities to increase awareness of the problem and provide more resources to help children get on the path to success.

“I would like to provide healthier homes and a more stable living environment,” Anderson said. “The families we work with are worried about where their next meal is coming from; they worry about if they are going to be able to pay next month’s rent. They are worried about cars, jobs, immigration. Stable housing is a big factor when it comes to lead and kids getting poisoned.”