There is no mandate in Pennsylvania for all children to be tested for lead exposure by a certain age.

However, the early periodic screening diagnostic and treatment program, administered by the Department of Human Services to children on medical assistance does require testing at ages 1 and 2 although compliance is not 100 percent across all providers.

Dr. Fiona McLellan, associate director of Altoona Family Physicians, tests all children regardless of whether they are on medical assistance or not.

“It’s definitely a problem in this area,” she said. “Because of the prevalence in this area, we try to test all children,” she said. “We’ve picked up elevated results in kids who have other insurance.”

The initial test is a finger prick.

An elevated blood level result for a child is a result of 5 or more micrograms per deciliter of blood. A microgram is one millionth of a gram, and a deciliter is one-tenth of a liter.

If the result is higher than 5 micrograms per deciliter, McLellan repeats the test with a veinous blood draw and discusses it with the state Department of Health. The immediate treatment is to decrease exposure to lead in the home.

“The first thing is to figure out why that child has elevated levels. Is it paint or some other thing? There are things imported from other countries that are not so well-regulated — cheaper jewelry and toys are still a problem because they are imported from elsewhere.”

The United States did not ban the use of lead in consumer-used paint until 1978.

“Unfortunately a lot of our homes were built before 1978. Our children are still being exposed to lead,” she said. “There are environmental investigations that can be done. There are ways of helping homeowners. Often times the families I see are really surprised about lead in their homes. They rent or buy and have no idea … and suddenly they are unmasking layers of lead.”

The Pennsylvania Department of Health childhood lead surveillance annual reports show that in 2017, the number of children less than 7 years old in all of Blair County with elevated blood levels of lead was a little more than 8 percent or about 100 of 1,220 tested.

The 2017 rate for Blair was higher than the statewide rate of 6 percent.

In 2014, the city of Altoona’s rate of children under age 7 with elevated blood lead levels was at 20 percent, or 162 of the children tested that year. Altoona’s rate was double the state exposure rate of 9.37 percent.

McLellan said her practice’s results are reflective of those reports.

“It’s a relatively small percentage, but it puts children at risk for a number of problems,” she said.

“Symptoms can be vague — belly pain and constipation can be subtle symptoms of lead exposure — muscle weakness … and young children can’t vocalize what they are feeling. With exposure in elevated ranges, symptoms include seizures, and learning disability takes root over time. It’s important to screen babies because they are very vulnerable. They may chew on the windowsill, put toys in their mouth.”

If pipes are a problem, McLellan advises not to use hot water from the faucet for baby bottles but always use cold water and boil it.

The children she usually sees have blood-lead levels on the lower end, between 5 and 20 micrograms per deciliter.

“No level of lead is safe,” she said.

Guidance from the Centers for Disease Control and Prevention used to suggest that an elevated blood lead concentration was 10 micrograms per deciliter. But that changed to 5 micrograms.

“Mitigating exposure is key so that the level starts creeping downward,” McLellan said.

Chelation therapy is considered only when a child is found with a test result of greater than or equal to 45 micrograms per deciliter of lead in blood. The medication is potentially harmful and binds with lead in the body so that it’s excreted in urine.

Even though no medical treatment is recommended for children with blood lead levels lower than 45 micrograms per deciliter, parents will know they need to learn about sources of lead exposure and find out if one or more unrecognized sources of lead are present in their home. Parents then can follow the CDC’s recommendations to control exposure to lead.

Mirror Staff Writer Russ O’Reilly is at 946-7435.