Dear Doctor: My 5-year-old grandson craves lead paint and has used his toothbrush to get at old layers of lead paint in his family’s renovated 1880s home. His development has slowed, and people think he’s autistic. If it’s the lead, what can we do?
Dear Reader: Your question covers several issues. We don’t make diagnoses in this column, so we would just note that the impulse to eat nonfood items — such soil, chalk, clay or lead paint — can be a disorder known as pica. The cause of these persistent cravings isn’t known, but pica has been associated with certain nutritional deficiencies, and with certain mental health conditions. The disorder can lead to serious complications, including intestinal blockage, parasitic infection and lead poisoning.
The United States government banned lead-based paints for residential use in 1978, but it remains a hazard in millions of older homes. Lead is a heavy metal that our bodies can’t use. When ingested, it interferes with numerous metabolic processes, including the production of red blood cells, absorption of calcium for bone and tooth development, and the proper functioning of the liver, kidneys, blood vessels, immune system, nervous system and the brain.
Lead is particularly harmful to the developing bodies and brains of babies, children and adolescents. In high amounts, it can be fatal. Even low levels of lead have been linked to impaired or delayed physical development, low IQ, learning disabilities, and emotional and behavioral problems.
Lead is a cumulative toxicant, which means it builds up in the body over time. As a result, symptoms of lead poisoning can take months or even years to appear. These include loss of appetite, abdominal pain, nausea and vomiting, chronic constipation, hearing loss, problems with vision, persistent fatigue, weight loss, tremors or seizures, irritability and the developmental delay that you report in your grandson.
Since you know your grandson has been eating old paint, it’s important to learn his blood levels of lead as soon as possible. Your family doctor can do this with a simple blood test. Blood levels of lead are measured in micrograms per deciliter, or mcg/dL. Levels as low as 5 mcg/dL are considered potentially unsafe and call for continued screening. It’s also crucial to find and eliminate all potential sources of lead in his environment. In older homes, deteriorating lead-based paint not only chips and flakes, it gives off contaminated dust that is easily inhaled.
In severe cases of lead poisoning, chelation therapy may be recommended. Although it can lower the levels of lead in the blood and soft tissues, it has not been shown to reverse the existing effects of lead poisoning. In this treatment, the child is given a medication that binds to the lead in the blood and soft tissues. It then forms a compound that can be excreted in the urine. Depending on the type of medication used, chelation therapy may be delivered orally or via an injection. Side effects can include headache, nausea or vomiting, and discomfort at the injection site. Chelation therapy should always be carried out under medical supervision, and only with prescription drugs.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.