Deborah Pinkerton took her grandson for his 18-month check up in August when his pediatrician found elevated blood lead levels.

When Pinkerton’s grandson had his first blood lead test, the results came back at 21 micrograms per one-tenth litre of blood – almost four times higher than the reference point the U.S. Centers for Disease Control and Prevention (CDC) uses to recommend a lead intervention involving environmental investigation and frequent follow-up testing.

More comprehensive tests to confirm lead exposure found that her grandson’s lead levels had actually reached 33 micrograms per one-tenth liter of blood – almost 6 times higher than the CDC’s intervention threshold.

“It was totally a surprise, he has no symptoms at all,” Pinkerton said, of her toddler grandson.

An environmental investigation by the Southern Nevada Health District found lead hotspots in plots of dirt around the family home, which the toddler had been eating.

“They said lead tastes sweet and maybe that’s what attracted him,” Pinkerton said. “I think a lot of people including myself think ‘well if the kids eat a little dirt it’s not going to hurt them’ but that’s not always the case.”

Doctors warn there is no safe level of lead exposure. High doses of lead can lead to seizures, coma, and death. But even blood lead levels below 10 micrograms per deciliter in children can lead to poor performance in school, loss of IQ, attention deficits, and behavioral issues.

“I was really surprised, you know I think most people are not aware. I’ve looked after a lot of kids I’ve got nine kids of my own and we’ve never been told much about it. We know lead poisoning is bad but we never heard about it too much around here,” Pinkerton said.

Nontraditional sources

Like many other Nevadans, Pinkerton assumed lead was a hazard that endangered only previous generations. Her home in Searchlight, Nevada was built in the 1940’s but had gone through multiple renovations. She never suspected the yard’s dirt could contain lead, which health experts said may have come from old industrial lots in the rural county.

Since the federal government mandated lead reductions in gasoline in 1972 and banned its use in paint for homes in 1978, the narrative has been that the chance of lead exposure has dwindled. But lead exposure can happen anywhere, anytime – as it did in Flint, Michigan, when improperly treated water began corroding lead pipes and releasing harmful chemicals into the tap water in 2014.

“We often think of the traditional methods of exposure like lead paint in older housing, but a great focus where we’re working with our medical providers is also to make sure we highlight the nontraditional sources of exposure,” said Erika Marquez, a research associate for the Nevada Institute for Children’s Research and Policy.

But Marquez said a perception among healthcare providers in Nevada is that lead exposure is not an issue, leading many to skip lead screening tests.

A 2017 University of Nevada, Las Vegas study Marquez coauthored revealed that 48 percent of physicians throughout Clark County who serve patients under the age of six did not follow CDC guidelines for testing children for blood lead levels, meaning many children may not be getting tested for elevated blood lead levels.

Physicians indicated that they did not test either because it was not a state mandate, because they believed that only children in high-risk housing required testing, or they did not test because colleagues had informed them that testing was not a standard practice in Nevada.

According to a legislative policy brief, less than three percent of Nevada’s 200,000 children are screened for lead, making Nevada one of the lowest screening states in the nation.

Marquez is hoping a bill she helped draft and that was signed into law by Gov. Steve Sisolak earlier this year will change that.

The bill, SB90, decreased the number of acceptable lead levels in children from 10 micrograms per deciliter —a measurement for blood lead levels— to 5 micrograms per deciliter in order to comply with Council of State and Territorial Epidemiologists recommendations.

The bill also requires health care providers, clinics and medical facilities to report the results of tests of children for lead to the proper health authority, which is required to track data for characteristics such as age, sex, race, ethnicity, and address of the child exposed, information not previously collected by the state.

Lack of a robust surveillance system to track at-risk children has made it difficult to identify patterns and potential clusters in childhood lead exposure at the local level, said Marquez.

“SB90 being passed was really integral to us,” Marquez said. “I think this will help inform what’s happening in our community and inform how we do education and outreach for our most at-risk communities in Nevada.”

While the law recommends physicians test for lead, it does not mandate testing, leaving outreach and education to health officials who must rely on national trends to identify and target at-risk populations until more data can be collected thanks to the bill.

‘A health equity issue’

The Nevada Childhood Lead Poisoning Prevention Program, a program funded by the Centers for Disease Control and Prevention through a $1.2 million dollar grant last year, launched a social media campaign on Facebook and Twitter through Nevada Institute for Children’s Research and Policy accounts for National Lead Poisoning Prevention Week to raise awareness of the new law.

“Most of the places we’ve done outreach are all low-income by nature because that’s the target area. They tend to have older houses and demographically it tends to be Latino and African American,” said Erick Lopez, a research analyst and PhD candidate at the Nevada Institute for Children’s Research and Policy at UNLV.

The outreach tour includes Arturo Cambeiro Elementary School and Ollie Detwiler Elementary School, which are in targeted zip codes for risk of elevated blood lead levels. They are both predominantly Latino schools.

“We are one of the most diverse cities in the nation,” Lopez said. “There is considerable exposure based on racial ethnic background, based on refugee status, it’s an important factor we need to consider,” Lopez said. “It’s a substantial health equity issue because predominantly it effects people of color and low income populations the most.”

Esmeralda Cabrera took her two year old granddaughter to her yearly check up in August, and her physician found an elevated blood lead level of 21 micrograms per one-tenth litre of blood. A lead abatement team also visited their home, across from Jerry’s Nugget Casino on Las Vegas Boulevard and Tonopah.

“It’s an older neighborhood but I don’t know where she could have picked it up,” Cabrera said in her native Spanish. The environmental team never found the source but Cabrera suspects a lot of scrap metal near the child’s father’s home.

“You have to educate yourself, you have to know, you have to learn. I have seven children and none of them had lead,” Cabrera said. “ I had my six kids and I never heard of elevated blood lead levels until this happened. Nobody ever talked about it. But now I know. We have to educate ourselves more.”