Prakash Chandran (Host): As a parent, you are always there to give your children what they need when they don't feel well. When they catch a cold, you give them medicine. When they fall and scrape their knee, you give them a Band-Aid. But what are you supposed to do when you realize your family and your children may have been exposed to toxic heavy metals like lead?

Here with us to discuss is Dr. Jason Yaun. He's the Division Chief of Outpatient Pediatrics, UTHSC, and Medical Director of Family Resilience Initiative at Le BonHeur Children's Hospital. And we're going to talk today about the dangers of lead poisoning and the unique risks that exposure can pose to young children.

 Welcome to the Peds Pod by Le BonHeur Children's Hospital. I'm your host, Prakash Chandran. Dr. Yaun, thank you so much for joining us today. I really appreciate your time. Just to get started, what exactly about lead makes it so dangerous, and what effects can it have on the body over time?

Jason Yaun, MD: Well, thanks for having me today. The concerning thing about lead is it's invisible, and it provides toxic poisoning, essentially, to children. It affects them and impacts them at a really early age in life. It gets into the body, into the bloodstream, and then can be transmitted to the brain, to our skeletal system, and impacts just about every organ system within the body, and it can have long lasting detrimental effects on many systems. Most concerning around our learning, our impulsivity, our aggression, our behaviors, and it can have a lifelong impact on children. And we may not know that, especially at low levels of exposure and poisoning, until we see those detrimental effects later on.

Host: So, you know, one of the things that I talked about in the intro was exposure. Generally, where do people get exposed to lead in the first place?

Jason Yaun, MD: So most of the exposure these days is through ingestion. It's through sources of lead that are often in our homes and in our community. So through lead paint, lead in our pipes, so transmitted through our water. It can be in the air, it can be on lead paint on toys. It's been often found in foods and that's been a major source of news lately as well.

So it's typically young children finding those sources of lead in the home and ingesting those and providing that, that exposure and that poisoning. And the really scary thing is that it only takes a very small amount. One one hundredth of a sugar packet is enough lead to potentially provide that exposure and poisoning to a child.

So it's in our community. It's in our homes, especially older homes. Memphis has a lot of older, poor housing stocks. So we have over 200,000 homes in our community where children are potentially being exposed to lead, not to mention their daycare facilities, their schools, and other places where they spend a lot of their time.

Host: Yeah, so one of the things that I'm getting here is that it's kind of everywhere, right? And you mentioned one one hundredth of a sugar packet. That's not really that much. Is there any safe amount of exposure just given to the fact that it is in so many different places?

Jason Yaun, MD: So you're right, there's, there's no safe amount of exposure to lead. A lot of this is about primary prevention. Preventing children from ever being exposed to lead. So being mindful of those sources of lead in the home. So things like running our water on cold for one to five minutes before we use that water for cooking or to make bottles or use as drinking water, making sure that we're cleaning high touch surface areas around doors and windows that may have lead paint and dust from lead paint and other sources of lead. And being very mindful of what children are putting in their mouths and making sure that we're washing their hands and keeping the home clean using environmentally safe materials do that as well.

Host: Now, you kind of talked about the long term effects. Is any part of lead exposure reversible, or are those effects, once the children have them, they're just there for life?

Jason Yaun, MD: That's a really good question. We talk a lot about that they are irreversible. The good news I think is once we identify children as being exposed to lead, there are a lot of wraparound support services and those interventions do show success, but I think long term the consensus really is that once a child has been exposed to lead, that damage has been done.

And so again, it goes back to that primary prevention approach. You know, we do have secondary and tertiary, approaches for children who have been exposed to lead and that we've identified and, and need that help, but ideally we would prevent that exposure altogether. And to do that, we need systemic, large scale comprehensive changes in our community.

Host: Understood. So, I mean, speaking about the community specifically, you kind of talked about some of the more common exposure points, like the paint and pipes and even on some toys. Are there any exposure points that seem to be more prevalent especially in the area, in our community?

Jason Yaun, MD: In Memphis right now, we put a lot of thought and energy into exposure in homes. So precisely, the lead paint that is common in older homes or homes undergoing renovation. So, these often also occur in areas of low housing investment and areas of high poverty. And so those children may be even higher risk, but also homes undergoing renovation, older homes. So if the child's in a perhaps a grandparent or another caregiver home as well, those may be places of exposure. And then, of course, since 2014, when we learned of the Flint water crisis, our lead pipes have gotten a lot of attention as well.

We know that Memphis and many communities throughout the nation continue to have a large number of lead pipes and fortunately, we're seeing some initiatives underway to begin to replace those pipes, but it's also could be the pipes leading to the house, fixtures, things like that. And again, that exposure may happen in daycare centers and schools as well.

So it's important to think about those sources of exposure, testing, and again, prevention.

Host: Now, are there any exposure signs that caregivers should look out for in children that might tell them that they have ingested or been exposed to lead?

Jason Yaun, MD: So at higher levels, we do see some clinical symptoms of lead poisoning. So, again, we want everyone to have a zero level of lead exposure. Our current cutoff for action in the United States is a level of three micrograms per deciliter or higher. So that's kind of our cutoff for action.

But we know even from levels from one to 10, we may see impact on a child's IQ, on their future learning, their behaviors and things like that. But that may not be readily evident and may not be determined for a number of years. But in the short term, levels above 20, we can see things like gastrointestinal symptoms, such as abdominal pain, constipation. At higher levels, we may begin to see some cognitive changes and at extremely high levels, you can see things like seizure, coma, or unfortunately, even death.

Host: You know, just hearing all of this, I think awareness and prevention is so incredibly important. Obviously, we're doing this podcast, but I'm curious, does Le BonHeur have any sort of programs or initiatives just to increase the awareness around lead poisoning?

Jason Yaun, MD: Yeah, Le BonHeur has been a great community partner in this area over the years. We've gotten numerous different types of grant funding to go into homes, test homes for lead, things like water and paint. And to provide some of those interventions, should we determine that there is lead in the home.

We partner with our local government, Green and Healthy Homes Initiative, the federal government on ways to determine if children are being exposed to lead in their homes, and then to provide those interventions that may be needed to prevent those exposures.

Host: So just as we start to close here, Dr. Yaun, is there anything else that you think caregivers should know about lead poisoning or exposure, especially in young children?

Jason Yaun, MD: Well, all children should be screened for lead exposure and lead poisoning at 12 and 24 months of age. I think that's important for caregivers to know. Also, our pediatricians to know. You know, the good news is we have seen a drastic decline in lead poisoning over the last 40 years. But that doesn't mean that it's not still a community issue that could be leading to a lot of problems for our children down the road.

So, caregivers need to be aware of exposure potentials, the screening process, reasons that they may need to talk with their pediatrician about lead. So, making sure that, that blood screening test is being done. If there have any playmates or siblings that have lead exposure, then that child should also be tested.

So just being aware of sources of lead, reasons to talk to your pediatrician, making sure that those blood tests are being done, and just watching out for any signs or concerns around these issues.

Host: Yeah, and actually something that you said made me think about just the age a child is at risk in general. What are the most sensitive and pivotal ages to really think about prevention? And after a certain age, does it become less of an issue?

Jason Yaun, MD: Yeah, it's really kind of age three and under, but we screen all the way up, generally up until age five. And there's a couple of reasons for that. A, the brain is undergoing a lot of development. So systems can really be impacted by lead exposure, but also when we think about that hand to mouth activity.

So children putting things in their mouth, where they may be at high risk for ingesting that lead dust or that lead paint chip or things like that. Those types of behaviors tend to you know, dissipate around two or three years of age.

Host: Okay. Good to know. Well, Dr. Yaun, I really appreciate your time today. This has been a wonderful conversation. Thank you so much.

Jason Yaun, MD: Thanks for having me.

Host: If you found this podcast to be helpful, please consider sharing it on your socials and check out our full podcast library at lebonheur.org/podcast to find more topics of interest to you.

 I'm Prakash Chandran and this has been the Peds Pod by Le BonHeur Children's Hospital. Thanks for listening.