What Freehold Borough Schools found when it screened kids for lead

Steph Solis | Asbury Park Press

Show Caption Hide Caption Watch: How does lead get into your water Water typically leaves a treatment plant lead free. It's on its way to your home that lead gets into your water.

FREEHOLD BOROUGH - One by one, the kindergarten students entered the nurse's office and held out their hands for a small pinprick.

The nurse drew the blood into a tube, placed it into a machine and in a matter of minutes determined whether the child sitting in front of her had been exposed to lead.

"It was a great opportunity for us to look at some of the kids that may be at risk and be able to find out if that is indeed the case," said Margaret Jahn, a health officer for Freehold Township, who helped organize the screenings in mid-June.

Freehold Borough Schools ended the school year with its first lead screening for young students — a rarity for New Jersey public school districts. A nurse and local health official screened more than 60 students up to age 6 for signs of lead exposure as part of a local campaign to help families who may not have access to early screening and treatment.

And it didn't cost borough taxpayers a dime. The Freehold Township Board of Health donated the equipment and their time.

The tests were conducted in Freehold Learning Center, Park Avenue Elementary School and other elementary schools where the district rents out classrooms.The effort sought to close a gap in lead testing.

While state law doesn't require schools to test or treat students for lead exposure, health advocates say schools can help identify whether their students are at-risk and need special education and other services as a result of lead exposure.

"Once a child finds out he's lead poisoned, the lead is there, you can't reverse it," said Manalapan-based neurologist Ted Lidsky.

Lidsky, who has worked in more than 15 states throughout his career, says schools should conduct these blood tests as well as neurological evaluations for at-risk students. He said that historically school districts have not confronted the neurological effects of childhood lead exposure and how those children can struggle in reading, math or other subjects down the road.

Ordinarily, children as early as age 1 and as old as age 6 are screened at their doctor's office or at a federally qualified health center. Families without health insurance can also go to the local health department for testing options, but local health officials say that doesn't always happen — even though the stakes are high.

Lead exposure affects every part of a child's body, creating long-lasting physical and mental damage. There is no "safe" level of lead, but state law requires doctors to flag infants and young children whose lead levels are at or above 5 micrograms per deciliter.

New Jersey identified 4,800 young children with elevated lead levels in their blood (at or above 5 micrograms per deciliter) in 2016, the most recent data available.

In Freehold, physicians identified seven children with elevated blood levels out of 385 children between 6 months and 26 months of age in 2016, but that was only 59 percent of the population of children in that age group. Jahn said this means the public doesn't have the most accurate picture of how many children in this age group are at risk for lead poisoning.

Nor do those numbers account for older children with signs of lead exposure or who have never been tested.

"The actual screening in Freehold Borough has not been as robust as it needs to be," Jahn said, noting that 85 percent of the housing stock was built before 1978, when the federal government banned the use of lead-based paint, and could be at risk for lead contamination.

"We know there's a risk, but I don't believe we have a true indication of what hazards may be out there and the kids being exposed to that," she added.

Jahn cited a variety of reasons why kids might not get tested:

Parents might not have insurance.

Pediatricians might send parents to laboratories offsite for testing, which can be difficult for parents without cars or, in the case of undocumented immigrants, who fear being detected by immigration authorities.

Parents may not understand the risks of lead exposure.

Parents may fear getting kicked out of their rental homes if their child tests positive for lead. Jahn says landlords have evicted families after health officials inspected the homes of exposed children and found lead in paint or pipes.

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The state doesn't require that schools be notified of a child with elevated lead, which the Asbury Park Press confirmed in a survey of schools in 2015. Schools may not know which students have lead poisoning and may need special education or other services.

Newark public schools screened students for lead exposure after the state Department of Environmental Protection found drinking water in all 30 schools had high lead levels, the Star-Ledger reported in 2016. Freehold Superintendent Rocco Tomazic said he drafted the screening initiative after learning about the barriers to childhood lead screening at meetings held by the Neighborhood Connections to Health coalition.

Tomazic said he reviewed student data and found more than 160 students age 6 and under lacked documentation showing they were screened for lead. So he decided to offer the screening services on school grounds.

"We know that if you're going to learn well, you have to be healthy. We knew that there were some structural problems within Freehold Borough that not all of our students were being served and we tried to do as best we could," Tomazic said.

He distributed permission slips to those students and got back 162 approvals from parents, or one-third of the at-risk students in that age group.

Two students tested positive for lead exposure. Jahn said after further testing, one of those students turned out to be a "false positive." Health officials are awaiting results for the other.

It was lower than health and school officials expected.

"That was good news," Tomazic said, "but we wouldn't have known that unless we took the time and effort to do the testing."

Catching early signs of lead

Physicians used to flag children who had more than 10 micrograms of lead per deciliter. In 2012, the Centers for Disease Control updated its rules to require that physicians flag children with more than 5 micrograms per deciliter so they can intervene earlier, inspecting their homes and other areas for traces of lead.

The state Department of Health changed its threshold from 10 to 5 micrograms per deciliter in September.

"A lot of the cases we saw fall between 5 and 10 (micrograms). If you get two of those in a row, you have to respond. In the past, you could get (a kid at) 7 and 8 and we would never visit you," Jahn said.

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Before that change, the local health department would see one or two children who qualified as having elevated lead levels each year. Between September and June, that number jumped to 15.

Jahn attributes the increase to the new screening standards and recent awareness campaigns reminding physicians to get kids tested.

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Increasing childhood screenings are one of several improvements that advocates say are needed to fix New Jersey's childhood lead problem. Advocates suggested a series of fixes ranging from committing funds to the Lead Hazard Control Assistance Fund, which has been raided by lawmakers, to requiring that rental homes be certified as free from lead.

The report suggested it would cost lawmakers more than $1 billion to fix these hazards.

But the Freehold Borough Schools' lead screening initiative shows there are low-cost or free ways to identify at-risk children, health officials say.

That’s what drew Ethan Reich’s parents to the program.

His father, Adam Reich, said Ethan doesn't show any outward signs of fatigue, developmental delays or other symptoms of lead poisoning. The 6-year-old boy loves taekwondo, Legos and coloring books.

Still, Adam Reich said he felt it would be foolish to pass up the opportunity.

”I think that anything that can be done to make sure our kids are growing up healthy and strong — especially one that has no cost to parents — should be taken advantage of," said Adam Reich, 38, who grew up in the borough. "I didn't have a major concern beforehand, but it gives me peace of mind to know that I shouldn't be concerned."

The student who tested positive during the screening will undergo further testing to confirm the elevated blood levels. If the student continues to test higher, Jahn said a nurse will contact the family and pediatrician to undergo further tests and follow-ups. That often includes inspecting the home and checking for physical or neurological deficiencies that may be related to lead exposure.

Lidsky, the local neurologist, said the lead screenings are a good first step and should be followed by different approaches to testing and treatment for older children who missed out on lead screenings.

"You have generations and generations of kids who were poisoned by lead," he said.

The school district may cast a wider net next time it conducts the screenings. Tomazic said health officials expressed an interest in holding another lead screening, this time geared toward older students who may consume lead-ridden candies or have lead in pottery at home.

Steph Solis: @stephmsolis; 732-403-0074; ssolis@gannett.com.