This article first appeared in the St. Louis Beacon, Nov. 15, 2010 - Nothing speaks louder to a mother than a silent child.
When Larry Chavis was about 2, he'd sit in the middle of the floor in a room full of teddy bears, toy cars and trucks, but he didn't seem interested in playing with them. His perplexed mother, Achaia Robinson, sensed something wasn't quite right with her son; she was confused by his dazed look and his tendency to keep to himself.
"He was just lying around; he wouldn't play and wouldn't eat," she says. She later learned from medical tests that her child didn't seem like himself because he was suffering from a serious case of lead poisoning.
Public health officials are alarmed when a child's blood-lead level is above 10 micrograms of lead per deciliter of blood. Larry's level of 28 micrograms was nearly three times the acceptable limit. (A microgram is a millionth of a gram; a deciliter is one-tenth of a liter.) The small numbers show how little lead needs to be absorbed into the body before it harms a child.
After coming to grips with the reason for her son's behavior, Robinson prepared for the time when she assumed he'd be taking plenty of shots and pills -- and perhaps suffer through painful chelation treatment for removing the lead. But she discovered that the remedy for his lead level was so simple that doing it after Larry's birth might have lessened or prevented the unacceptably high level of lead from building up in his body.
"They told me to feed him plenty of fresh fruits and vegetables," Robinson recalls, sounding a little puzzled by this relatively easy solution to such a serious health problem. It's a remedy that surprises many people who have never been told the value of a healthy diet in fighting and preventing lead poisoning.
That's because the public tends to think about the problem only in the context of a child's exposure to lead dust and peeling paint in older homes, and not alternatives to these problems. Many parents are unaware that they can be proactive by feeding their children calcium- and iron-rich foods.
Education Is A Key To Prevention
Every city and state health agency, along with federal agencies such as the Environmental Protection Agency, include this message on their websites and in their brochures. Aside from encouraging hand washing and keeping their kids out of the way of lead hazards, parents are urged to provide youngsters with regular meals because empty stomachs absorb more lead. They also are told to avoid feeding their children fried foods and to limit their intake of oily foods, potato chips, cakes, cookies, doughnuts and other foods high in fat.
Typical advice is on the Missouri Department of Health and Senior Services' website. It reminds parents, childcare workers and others that iron-deficiency anemia has been associated with increased susceptibility to lead poisoning.
Life In A Food Desert
It's advice that families in suburbia and solid neighborhoods in the city find easy to follow since many have access to convenient grocery stores and tend to encourage their children to eat healthier food. But even if most poor families in St. Louis made the connection between fresh foods and lead, some of them face a hurdle. Full service supermarkets tend to be limited or nonexistent in some St. Louis zip codes or neighborhoods where poor children seem most vulnerable to lead, says Jeanine Arrighi, the Slay administration's manager for child environmental health issues. She adds that some families do not routinely make sure their children get enough fresh fruits and vegetables.
"We know our diets in this day and age are not as good as they were 30 or 40 years ago," she says. "Kids don't eat good healthy food the way you and I ate as children. There's too much fast food and there's the food desert. Kids don't get the calcium and iron they need to help their bodies protect them from the lead exposure."
At one time, a full-service grocery store was located about half a mile from Robinson's home. After that store closed, the closest high-quality food store was built about two miles away. The family home is closer to fast-food outlets and a service station that doubles for some residents as a mini-grocery store. But Robinson says that after lead became an issue, she chose to feed Larry plenty of fresh foods and give him beverages with less sugar as well.
She says it helps that he isn't the type of child who thumbs his nose at spinach and other healthy foods. Still, research shows that making full-service groceries convenient can influence whether families shop at nearby corner stores or visit the supermarket that might be several blocks or miles away.
Rescuing Larry
In any case, convenient access to fresh fruits and vegetables seemed to have been a secondary issue in Larry's case. He was poisoned by lead dust and chipped paint in the two-story rented house where the family still lives. His high level automatically triggered the city's response of addressing lead hazards in the windows and porch at the house, moves that have helped to reduce the child's lead problem to an acceptable level.
The city's program includes replacing windows, repainting rooms and addressing other lead hazards -- and it works. Robinson is thankful for it, saying, "my son would be really sick" had the city not stepped in. Because of a steady diet of fresh foods, the repainting, the cleaning and medical attention, Larry, now 4, had a lead level down to about 5 micrograms by this summer, well within what's considered a safe limit.
More Work To Be Done
Arrighi has thought a lot about Chavis' case, remarking that "our goal is to eradicate lead poisoning." The city is far from doing that, but it has made lots of progress since 2003 when Mayor Francis Slay declared war on lead by starting his Lead Safe St. Louis program. Before then, environmental groups had complained that it would have taken the city a century to address the problem had it stayed the course of trying to find money to completely remove all the lead in older homes rather than replace windows and doors in housing and neighborhoods where the lead problem was worse.
Because the city has now chosen to focus on window treatments and other less expensive approaches, the lead poisoning rate has dropped to 3.2 percent. That's remarkably low in light of the fact that the rate was as high as 48.5 percent in 1992.
Another more far-reaching approach to the problem will come if the Obama's health program remains on track. The Affordable Care Act sets aside $90 million this year for evidence-based home-visit programs to improve children's health in poor neighborhoods. This should mean putting more health workers into poor communities to help families avoid problems such as lead poisoning. The program is expected to provide outreach services to children up to age 8.
In addition, researchers continue to look at the consequences of lead poisoning beyond health. Studies are being done to determine the indirect influence of lead poisoning on the incidence of crime. Another fertile area for study is the relationship between lead levels and school performance. What's described as a groundbreaking study by Detroit city and school officials found that roughly 58 percent of the students tested had a history of lead poisoning. The study showed that the higher the lead level, the worse the students performed on Michigan's equivalent to the MAP test. St. Louis school officials say they don't keep data on students with histories of lead poisoning.
Robinson says she wishes St. Louis had a law requiring that every home be inspected for lead before pregnant mothers and small children may move in. The city has taken that approach in some high-risk neighborhoods, but money for it is limited.
In the meantime, Robinson is elated by her Larry's progress. She talks about him as if she's speaking of a different boy than the one that caused so much concern two years ago. She says he gradually began to enjoy carrying on imaginary conversations with his teddy bears, wearing the wheels out on his toy cars and trucks and interacting well with children at the child-care center where he's enrolled while she attends ITT Institute. But as she talks about the future, Robinson tempers her optimism with guarded responses, her voice deepening as if the sound is coming from a woman much older than 22.
"I was really hurt when I found out he had lead poisoning and found out later how it might affect him," she says as her hands play with a cell phone.
After a long sigh, she adds: "He's OK right now. But you can't really tell until he gets older. I just hope he doesn't get it again."
This story was written with the assistance of the Dennis A. Hunt Fund for Health Journalism, which is administered by the California Endowment Health Journalism Fellowships, a program of USC's Annenberg School for Communication and Journalism. Funding for health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization whose vision is to improve the health of the people in the communities it serves.
