Lead Exposure in Childhood: What Families Need to Know

By Richard Zhang, M.D., M.A. and Eunice Y. Yuen, M.D., Ph.D.

The Los Angeles urban wildfires have devastated families and communities with agonizing loss. Residents’ most prized possessions and decades-old homes have become reduced to smoke and ashes. Lives have been put at tremendous, immediate risk. Further still, another danger has arisen from the wildfires—large amounts of inhalable, airborne lead. The tragedies vividly remind us how lead, a neurotoxin, can still present in communities and silently undermine our children’s health.

Societal exposures date well back, with evidence in the Roman Empire of silver-mining projects dispersing atmospheric lead and water-supplying aqueducts containing lead. The metal’s historical appeal stemmed from its ease of underground extraction, corrosion resistance, and malleability. Millennia later, the same qualities partly explain why an estimated 9.2 million lead service lines still exist in the US, and why the 2014 Flint water crisis occurred. The substance’s durability and practical chemical properties likewise explain why it took many decades before lead paint and leaded gasoline became banned in 1978 and 1996, respectively.

In May 2024, the US government released a report detailing federal progress made since 2018 in reducing childhood lead poisoning. It described various removal projects nationwide, proposed or implemented, ranging from replacing leaded water pipelines to eliminating lead paint sources in older homes. Yet, despite these significant initiatives, the report also acknowledged room left for progress. Lead exposure among Americans has greatly decreased since the 1970s—perhaps by over 95%—but continues to cause long-lasting health problems in some youth and families, especially in under-resourced communities.

Lead toxicity and impacts on children’s brains

No amount of lead is safe in the human body. Likewise, no known natural role exists for lead in the body. It is toxic to all organs, whether the brain, heart, or kidneys. Lead exposure typically happens through ingestion by mouth or inhalation, and is physically absorbed as much as four to five times more readily in young children than in adults. Massive, acute lead poisoning can present with observable symptoms warranting emergent medical evaluation, such as nausea, fluctuating levels of wakefulness, difficulty walking, and even seizures. Prolonged low-level exposures, which can be subtle and difficult to notice, can also exert insidious, long-term harms to children’s development.

The developing brain is highly sensitive to contact with lead. Dynamic, continuous, and crucial processes such as myelination take place in the young brain to sufficiently and efficiently wire it into optimal functioning by adulthood. When lead is absorbed by the body, it readily crosses over from the bloodstream into the brain and disrupts those processes. It competes with, and falsely mimics, molecules such as calcium that help regulate normal neurological functions. Lead also interferes with the GABA neurotransmitter system, leading to harmfully excessive neuronal activity. As such, sustained lead exposure injures and stunts the growth of various brain structures and connections.

Damages may persist even after subsequent removal of lead exposure sources. This may result in long-lasting deficits in one’s intelligence, mood regulation, attention, impulse control, decision-making, and educational attainment. This aligns with population-level research on the lead-crime hypothesis; even a cautious meta-analysis study utilizing extensive research on the topic acknowledges environmental lead reductions may have contributed to up to 28% of the recent decrease in US homicides.

Household sources

While less prevalent now than a century ago, depending on location, environmental lead sources may be present in one’s community. Examples include industrial air emissions, disasters like the LA urban wildfires, and contaminated water and soil. Their extent and proximity determine the degree of health risk. More addressable lead sources may exist within one’s own household. Paint can flake from unrenovated, deteriorating walls and windowsills in some US homes built before 1978. The resulting lead paint chips’ sweet taste and ease of plucking the chips from a wall make them especially prone to consumption by toddlers and young children. Even the process of renovating these older homes can pose risks when not completed carefully, as remodeling their walls may emit breathable lead dust.

Within bathroom and kitchen cabinets, families should recognize the potential for certain imported items to contain lead, as not all countries have the same anti-lead regulations and extent of enforcement as the US. Examples include some types of imported herbal medicines, spices, hand-painted ceramics, and toys. Domestically, lead particles can be brought into households from caregivers’ workplaces. Some occupations can expose employees to lead dust, such as construction, roadwork, and battery-manufacturing. Parents in such fields may unintentionally bring lead particles home if they do not change or sufficiently clean their clothes before leaving the workplace.

What can parents do to protect their children from lead poisoning?

Preventing childhood lead exposure warrants removing risk factors. As discussed above, US homes built before 1978 carry the potential for having chipping lead paint and dust. Owners of such older homes should:

• Regularly check painted surfaces for chipping or peeling paint, which can be carefully removed with a damp paper towel and disposed of in the trash. Painting over the lead paint after chips are removed is typically effective in preventing chipping lead paint.
• Gently clean smooth surfaces with damp, non-abrasive implements that limit the accidental spread of lead dust. The Environmental Protection Agency provides further details on maintaining pre-1978 homes.
• Consider requesting professional inspections for lead, especially when there is planned remodeling or other potential triggers for home lead dispersal.

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Caregivers in housing of any age can:

• Exercise caution when considering buying certain imported herbal medicines, hand-painted objects, spices, and metal jewelry.
• Have children regularly wash their hands before meals and after playing outdoors, to reduce lead ingestion risk.
• Ensure children have nutritious diets, preferably low-fat and containing leafy green vegetables, that provide sufficient iron, calcium, and vitamin C which partly reduce bodily absorption of lead.
• Ask the child’s pediatrician whether blood testing should be considered, depending on a range of locational, demographic, and other risk factors even when lacking symptoms.

Mild lead toxicity often does not look symptomatic, but observable symptoms that do occur may warrant urgent medical evaluation, especially if children reside near suspected lead sources. Examples include:

• Developmental delays, such as in hearing, walking, and speech
• Increased irritability
• Persistent fatigue
• Abdominal discomfort
• Nausea and vomiting
• Constipation
• Muscle aches
• Seizures

Childhood lead exposure is not as prevalent as in the past; however, with proper societal awareness, education, and intervention, it also does not have to be a problem of the future.

Richard Zhang, M.D., M.A. is a child and adolescent psychiatry fellow physician at Yale Child Study Center. Concurrently, he pursues advocacy as an APA/APAF Leadership Fellow, a GAP (Group for the Advancement of Psychiatry) Fellow, and an affiliated faculty at the UConn Asian and Asian American Studies Institute.

The authors would like to thank Dr. Dorothy Stubbe from Yale Child Study Center for her helpful review of this article.