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Children showed greater blood lead levels after switch to Flint River water
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Recent data published in MMWR showed that young children living in Flint, Michigan, had higher blood lead levels after the city switched to water sourced from the Flint River.
“This crisis was entirely preventable, and a startling reminder of the critical need to eliminate all sources of lead from our children’s environment,” Patrick Breysse, PhD, director of the CDC’s National Center for Environmental Health, said in a press release. “CDC is committed to continued support for the people of Flint through our Childhood Lead Poisoning Prevention program and efforts to raise awareness and promote action to address the critical public health issue in communities across the country.”
In April 2014, Flint switched from water sourced by the Detroit Water Authority to water sourced from the Flint River. During this time, corrosion control measures were not used to reduce potential lead exposure, the report said. Lead exposure via water consumption or contact is associated with adverse health events, according to the report.
The investigators stated that very young children are at an increased risk for adverse health events because they consume more water per unit of body mass and are more likely to engage in hand-to-mouth behaviors than older children and adults. In January 2015, city officials released a water advisory after detection of increased blood lead levels and lead water levels. To assess the impact of this exposure, the CDC examined the prevalence of increased blood lead levels among children living in Flint.
The investigators found that even after adjusting for external factors, such as season and age, children aged younger than 6 years were at risk for blood lead levels greater than 5 µg/dL during the period after the switch. Of the 7,306 children aged younger than 6 years whose blood lead levels were tested from August 2013 to March 2016, 3% had elevated blood lead levels of at least 5 µg/dL. The proportion of blood lead levels was 5% for the early time-period during use of the Flint River water vs. 3.1% during use of water sourced by the Detroit Water Authority.
The report advised that all children living in Flint aged younger than 6 years old should undergo blood lead level testing if they have not been tested since October 2015.
“Flint residents have been recently advised by the U.S. Environmental Protection Agency that when using an approved and properly installed and maintained water filter, it is safe for persons to drink filtered tap water, including pregnant women, nursing and bottle-fed children, and children aged younger than 6 years,” Kennedy and colleagues wrote. “Regular household tap water can be used for bathing and showering; however, young children should be prevented from drinking bath water.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Helen J. Binns, MD, MPD
When pediatricians and primary care providers provide counseling about lead in water, they need to first determine if the water used by the family is from the city distribution system or from a private well. According to the US EPA, approximately 15% to 20% of households obtain their water from private wells. Private well owners are responsible for testing their own water. The American Academy of Pediatrics has published guidelines on testing of private well water.
For patients who use city water – or water that is coming from a regulated entity – they should be aware of whether they have lead sources that may impact water for their own house. Do they have a lead service line? Do they have areas in their plumbing that may have lead? Do they have lead solder in their pipes? Nearly all homes built before 1980 will have a lead water service line (which is the line from the street to the house) or have lead solder connecting the water lines.
In general, the regulated water in the US has pretty low levels of lead, but some areas may have more concern than others. However, even with regulated water, if the family has lead sources in the home water lines or fixtures, there can be variability in water lead concentration throughout the day. One way to lower water lead concentration is to flush the water and always use cold water for drinking and cooking.
The CDC recommends that if you have a lead service line, flush the cold water for at least 5 minutes (clothes wash, showering, etc.), then additionally run the kitchen tap for 1-2 minutes and store flushed water in a clean container for later cooking and drinking use. The long water flush is needed because of the wide variability in the length of water service lines, the structure of the plumbing pipes in homes, and the unpredictable diameter of the pipes due to varying levels of corrosion or sediment. Homes that do not have lead service lines may still have lead in the home interior plumbing and need a few minutes of flushing the cold water to get the lowest water lead concentration possible.
Bottled water is generally a safe alternative for parents concerned about lead levels in their tap water, although I do have some concerns with bottled water and children. I encourage parents to look for water choices that include fluoride, an important component to help build teeth that are more resistant to decay. Another option is using a water filter that filters for lead. Water filters designed for filtering lead can lower the lead to very low concentrations. However, remember to change the filters as instructed.
Lead in tap water would convey a continuous source of additional lead exposure for anyone using the tap water for cooking or drinking on a regular basis. However, in general, the lead in water is considered to be a fairly low-dose exposure, whereas other sources of lead like lead in paint can be high-dose exposure.
Additionally, we are working to prevent lead exposure from all types of sources, so I would caution parents that water is just one source among the many that we see out there; lead paint building components and soil exposures are additional sources about which parents need to be concerned.
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