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What Parents and Caregivers of Young Children Need to Know

What Parents and Caregivers of Young Children Need to Know

What Parents and Caregivers of Young Children Need to Know

You have learned that drinking water could be a significant source of lead exposure for infants and young children. You are concerned about your family’s health, and you want to know how to protect your family.  Understanding how to identify and address your family’s risk is a good place to start.

There is no safe level of lead in drinking water, yet lead is present in common plumbing materials. When water is in contact with these materials, lead can dissolve into the water.

The risk of lead in water at your home, work, or school depends on the plumbing materials used, water quality in your community, and a variety of other factors, such as how much water runs through your pipes every day. The Lead and Copper Rule (LCR) is a regulation created under the federal Safe Drinking Water Act. It establishes requirements for water utilities to reduce the amount of lead or copper that dissolves into water from plumbing materials, focusing on water treatment. The requirements control the amount of lead and copper in the water, but they do not ensure the water is safe to drink in every home.

All states must adopt requirements at least as stringent as the federal LCR. In June 2018, Michigan added requirements to its LCR to address lead in drinking water more proactively. It is now the most stringent rule in the nation.

View/Download the infographic outlining new requirements (PDF)

While water quality in your community likely hasn’t changed, the new information collected under the revised rule allows water utilities to identify risk and address lead in drinking water more directly and proactively. If the new data reveal higher lead levels, it means a more aggressive response to prevent lead exposure is appropriate, and may have been appropriate for some time. Better information allows water supplies to better inform and protect their customers.

The following FAQs will help you identify the risk in your home, provide strategies for reducing exposure to lead in water, and learn about health screening options.

Lead can move into tap water from water pipes and plumbing materials that contain lead, especially if the water supply is not properly managed to control for corrosion, as discussed here. This means that lead could be present in drinking water in property that has lead sources in household plumbing or in the water service line that connects the water main in the street to the property. Specific examples of household plumbing sources of lead in tap water are described here. The major concern for exposure is swallowing lead-contaminated water, whether as drinking water, other beverages prepared with water, food cooked with water, or rinsing after brushing teeth. Powdered infant formula should be prepared with bottled water or filtered water, as described here. Because skin does not absorb to any great extent the lead that leaches from plumbing into water, skin contact while showering, bathing, laundering, or washing dishes is considered safe.¹,² Exposure to water vapor from laundry, showering, etc.is also not a concern for lead from plumbing because the water-soluble lead does not easily evaporate from water into the air.² Additional information about steps consumers can take to reduce their risk of exposure to lead in drinking water can be found here and here.

Lead can be present in drinking water where there is lead in plumbing or in the water service line. Water pipes, plumbing fixtures and plumbing materials that contain lead can release lead into tap water. Specific examples of household plumbing sources of lead in tap water are described here. In addition, galvanized service lines and plumbing can increase the risk of lead leaching into drinking water, as described here.

Corrosion is a chemical reaction that allows lead to move from the pipes into the water, either dissolved or as small particles. Corrosion increases significantly if the water is too acidic (low pH) and has low amounts of minerals.¹ Other factors that affect water corrosiveness include water temperature, the condition of the pipes, and the amount of time water resides in the pipes.¹ Effective corrosion control by the water supplier limits corrosion in pipes and can reduce lead release into drinking water, as discussed here. However, corrosion control does not eliminate all of the risk of exposure to lead in drinking water.

Swallowing lead-contaminated water is the major concern for exposure if lead is in the drinking water. In addition to drinking as plain water, you can be exposed by using the water to prepare other beverages, cooking food, or rinsing after brushing teeth.¹ Some children may swallow lead in water in the bathtub, during showers, or even by drinking from the garden hose because these plumbing materials may have higher lead content as described here. Powdered infant formula should be prepared with bottled water or filtered water, as described here, to avoid lead exposure. Do not use water from the hot water tap for drinking or food preparation because it can have elevated levels of lead. These and other steps to reduce the risk of exposure to lead in drinking water are described here.

Because skin does not absorb lead from water, skin contact while showering, bathing, laundering, or washing dishes is considered safe. Likewise, exposure to water vapor from laundry, showering, etc.is not a concern for lead exposure because lead does not readily evaporate from water into the air.

Further discussion of activities that are okay or should be avoided if lead is in the drinking water are described here.

References:

  • ¹ Lead in Drinking Water (2019, July 30). In Centers for Disease Control and Prevention. Retrieved September 22, 2019, from cdc.gov/nceh/lead/prevention/sources/water.htm.
  • ² Agency for Toxic Substances and Disease Registry. Toxicological profile for Lead (Draft for Public Comment). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service; 2019.

If water has elevated lead levels, you should avoid swallowing the water.¹ You should not cook, prepare food and beverages, or brush your teeth with lead-contaminated water. You should avoid swallowing water while showering or washing your face if the water is known to have lead present. In addition, only use bottled water or filtered tap water to make powdered infant formula (more information can be found here). Lead in water is not readily absorbed by the skin.¹,² Likewise, lead does not readily evaporate from water into the air.² As such, lead-contaminated water is not a concern for exposure in the air or by contact with the skin while showering, bathing, laundering, or washing dishes.³ Also, dishes can be washed in water with an elevated lead level but should be dried right after rinsing.³

Avoid drinking, cooking, preparing food and beverages, and brushing your teeth with water that is known to have lead present. Lead that is swallowed can be taken up into your body, as described here, and make you ill, as described here. Because of increased vulnerability of infants to lead (described here), always use bottled water or filtered tap water to make infant formula, regardless of water lead testing results.

The most abundant form of lead found in drinking water is not readily absorbed by the skin.² Because skin does not absorb water-soluble lead, skin contact while showering, bathing, laundering, or washing dishes is considered safe.¹ Although showering, bathing, laundering, washing dishes, and cooking can generate water vapor, exposure through the air is not a concern because lead does not readily evaporate from water into the air.² Also, lead will not be taken up by dishes made of glass, metal, or porcelain when washed in lead-contaminated water.³ However, dishes washed with lead-contaminated water should be dried right after rinsing to reduce residue that might contain lead.³

References:

The U.S. Environmental Protection Agency (EPA) states that the lead action level of 15 parts per billion (ppb), as specified by the U.S. EPA Lead and Copper Rule, is not a measure of public health protection.¹ Look here for more information about the lead action level.

Federal and state regulatory agencies and national organizations have identified goals, recommendations, and action levels for different concentrations of lead in drinking water that are summarized below.

Lead levelSourceGoal, Recommendation, or Action Level
0 ppbMaximum Contaminant Level Goal in the Federal Lead and Copper Rule¹The level at which there are no adverse health effects from lead in drinking water
1 ppbAmerican Academy of Pediatrics²Lead in water in schools and child care facilities should not exceed 1 ppb.
5 ppbFood and Drug Administration Bottled Water standard³Lead in bottled water should be no greater than 5 ppb.
12 ppbAction level in the Michigan LCR starting June 1, 20254Corrosion control is not providing sufficient reduction in lead levels
15 ppbAction Level in the Federal Lead and Copper Rule¹Corrosion control is not providing sufficient reduction in lead levels.

References:

Michigan’s law is unclear about what responsibilities a landlord has when elevated lead is found in the water of a rental unit. The Michigan Lead and Copper Rule does not require landlords to take any action even if sampling results show lead concentrations above the action level, and landlords may even be able to refuse to allow their water supplies to replace the lead service line (if one is present). It is possible that basic landlord-tenant law applies to situations involving lead in water, but because the law is not clear, concerned tenants are encouraged to seek the advice of an attorney.

Generally, the law does not require much of landlords when it comes to lead and drinking water. For example, the Residential Lead-Based Paint Hazard Reduction Act of 1992 says that landlords must disclose lead paint hazards to interested renters.¹ However, there is no similar requirement to disclose the presence of lead service lines and plumbing to interested renters.² The Michigan Lead and Copper Rule (LCR) requires water supplies to disclose lead service lines to owners and occupants (e.g., existing tenants). The LCR also requires water supplies to deliver a copy of any tap water monitoring results to the occupants of the sites that are tested. There is no requirement, though, that landlords must pass this information on to future renters.

Furthermore, Michigan’s LCR requires water supplies to offer to replace lead service lines at their own cost. Yet landlords can still refuse replacement without tenants having a say.³

When a tenant finds elevated levels of lead in their water, Michigan’s drinking water laws do not require landlords to do anything in response. That doesn’t mean, however, that tenants have no rights. Basic landlord-tenant law may come into play.4

Landlords must ensure that their building is “fit for the use intended.”5 Landlords must also keep the property in “reasonable repair.”6 A tenant likely intends to use the apartment as a safe living space where he or she has access to clean drinking water. Therefore, a tenant may be able to argue that an apartment with high lead levels in the water is not fit for the intended use. Further, when the building’s lead service lines or lead plumbing contribute to the high lead levels, the “reasonable repair” requirement comes into play. Here, a tenant could argue that it is the landlord’s responsibility to replace the lines or plumbing.

Landlord-tenant law also says landlords cannot punish tenants who complain about living conditions by evicting them.7 Therefore a landlord cannot evict a tenant for expressing concern (to the landlord or to others such as the local water supplies) about elevated lead levels. If a tenant thinks they were evicted due to a lead complaint, legal resources may be available to fight the eviction and secure safe housing.8

Not all landlords will voluntarily address a tenant’s complaint about lead in the water. For landlord-tenant law to work, a tenant would have to sue the landlord. Michigan courts have not yet applied landlord-tenant law to situations that involve lead in water. This is why a landlord’s responsibilities under the laws are unclear. Where possible, tenants should seek the advice of an attorney.8

References:

  • ¹ 42 USC § 4852d (part of the Residential Lead-Based Paint Hazard Reduction Act of 1992); 24 CFR Part 35.
  • ² Cincinnati is the rare city that requires disclosure of lead service lines. Ordinance No. 185 of 2017, §6.
  • ³ Michigan Administrative Code, Rule 325.10604f(5)(c)
  • 4 There may be two types of claims: statutory law (see MCL 554.139) and common law (See, Secunda v. Gregory, 2019 Mich. App. LEXIS 312(2019). The claims are similar, but In a common law claim, the plaintiff would have to prove (among other things) that the landlord failed to provide reasonable care to protect the tenant from an unreasonable risk of harm caused by a dangerous condition. Common law claims also don't extend to open and obvious dangers while a statutory claim does.
  • 5 MCL 554.139.
  • 6 MCL 300.5720.
  • 7 Michigan Legislature. "A Practical Guide for Tenants and Landlords." , michigan.gov/documents/Landlord__Tenant_Guide_10-2005_142052_7.pdf
  • 8 Legal & Law Related Programs by County, State Bar of Michigan, michbar.org/public_resources/legalaid.

Discuss the blood test result with the child’s pediatrician to identify potential sources of lead exposure. You can also contact your local public health office to learn about resources available to families concerned about lead exposure.¹ You can locate your Michigan local public health office using the online Local Health Department Map.² The most important step is to remove the sources of lead so that there is no further exposure. Most local public health offices have a public health nurse on staff who will assist families with understanding risks and options for children with elevated blood lead levels and who will also help identify lead hazards in the home. Information on how to reduce lead exposure in drinking water can be found here. If the child’s blood lead level is dangerously high, a medical treatment may be considered that uses a chelating agent, a medicine that binds with lead to help the body get rid of lead. However, chelation therapy has not been shown to reverse or diminish adverse neurodevelopmental effects of lead.³ Eating a balanced healthy diet with foods with calcium, iron, and vitamin C may help keep lead from being taken up into the body after swallowing.

Children with elevated blood lead levels should be referred by pediatricians to local public health offices. Also, there are many resources available to families through the local public health offices as part of Michigan’s Childhood Lead Poisoning Prevention Program and Lead Safe Home Program.¹ You can locate your Michigan local public health office using the online Local Health Department Map². Most local public health offices have public health nurses on staff who will assist families with understanding risks and options for children with elevated blood lead levels and children at risk for elevated blood lead levels. Additional services include home assessments to help identify and remove lead hazards from the home environment and family lifestyle to ensure that all sources of lead are identified. Any treatment regimen that does not control environmental exposure to all sources of lead is considered inadequate.

The most important thing to do is to reduce the child’s exposure to lead.4 Treatment varies depending on how much lead is in the blood. Small amounts of lead in the blood are addressed by removing the source of exposure working with your local health department, and using approaches described in a factsheet from the Michigan Department of Health and Human Services.5 Actions you can take to reduce risk of exposure to lead in drinking water are discussed here and here. With elimination of exposure, the blood lead level will decrease gradually over time as the body naturally eliminates the lead. All siblings of a child with a high blood lead test result should be tested, also.

Children with extremely high lead levels in their blood may be recommended for hospitalization to receive a medication called a chelating agent, which binds with lead to help the body get rid of lead. However, a recent report from the U.S. Agency for Healthcare Research found limited evidence that chelation therapy improves long-term blood lead levels and neurodevelopmental health outcomes in lead-exposure children.³ A pediatrician experienced in managing children with lead poisoning should be consulted.

Because nutritional deficiencies, especially deficiencies of calcium and iron, can increase lead absorption from drinking water, a balanced healthy diet may help reduce lead uptake into the body. Consider adding milk, yogurt, cheese, and green leafy vegetables to increase calcium intake. Examples of foods with iron are red meats, beans, peanut butter, and cereals. Vitamin C is found in oranges, green and red peppers, and fruit juice.5

Pediatric Environmental Health Specialty Units (PEHSUs) are a source of medical information and advice on environmental conditions that influence reproductive and children’s health. They are academically based, typically at university medical centers and are located across the United States and Canada. These PEHSUs form a network that is capable of responding to requests for information throughout North America and offering advice on prevention, diagnosis, management, and treatment of environmentally-related health effects in children.6 The Great Lakes Center for Children’s Environmental Health is one of the 10 Pediatric Environmental Health Specialty Units across the country dedicated to children’s environmental health issues. The Great Lakes Center PEHSU’s primary area of focus is Region 5, which includes the states of Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin.7

This website contains information regarding state-wide programs available in Michigan to assist families dealing with lead exposure: michigan.gov/lead/0,5417,7-310-84216---,00.html

This website from the U.S. Centers for Disease Control (CDC) contains a wealth of information regarding childhood lead exposure and poisoning: cdc.gov/nceh/lead/default.htm

This State of Michigan website contains concise information regarding lead exposure, lead poisoning, and actions families can take to reduce lead hazards: michigan.gov/lead/0,5417,7-310-84213---,00.html.

This website contains contact information regarding PEHSU Region 5: pehsu.net/region5.html

This website provides information specifically on lead exposure from drinking water: dc.gov/nceh/lead/prevention/sources/water.htm

This website provides ways of protecting family from exposure to lead: epa.gov/lead/protect-your-family-exposures-lead

References:

The American Academy of Pediatrics (AAP) recommends when and how children should be considered for blood lead testing. ¹ This schedule currently recommends that parents first consult with a pediatrician to discuss potential sources of lead exposure in the child’s environment beginning at six months of age. However, if there is reason for concern for lead exposure, the parents should consult with a pediatrician or their local health department earlier. If a risk for lead exposure is found, such as living in a home constructed before 1978, then the pediatrician may recommend that the child’s blood be tested for lead. ¹ In addition, immigrant and refugee children, as well as children adopted from another country, should have an initial test of their blood lead level soon after arriving in the U.S. Also, only bottledvwater or filtered water should be used to prepare formula reconstituted from powder (further discussed here).

The American Academy of Pediatrics (AAP) and the U.S. Centers for Disease Control and Prevention (CDC) no longer recommend screening of all children for lead in their blood. However, many local and state agencies have guidelines for blood lead testing in certain communities that have higher risk for lead exposure. ¹ In particular, blood lead testing may be important for children living in older housing (built before 1978) that may have lead paint and lead water service lines. The State of Michigan has a Childhood Lead Poisoning Prevention Program and Lead Safe Home Program to assist target communities of concern for lead exposure. ²

Current recommendations from the AAP and CDC are that parents first consult with a pediatrician to discuss potential sources of lead exposure in the child’s environment. This risk assessment should be done at the following well-child visits to the pediatrician: 6 months, 9 months, 12 months, 18 months, 24 months, and at 3, 4, 5 and 6 years of age. If a risk for lead exposure is found, then the pediatrician may request that the child’s blood be tested for lead. ¹

A variety of potential sources of lead exposure in the child’s environment should be considered. The majority of exposures come from inside our homes from things such as dust, dishware and toys (especially if made outside of the USA), water that passes through lead pipes, and chipping paint that contains lead. Children living in older houses, built before 1978, are at higher risk for lead exposure from paint, lead contamination of soil outside of the home where children may play, and lead water service lines. Even lead paint that has been painted over several times can chip, providing an opportunity for children to pick up and swallow a paint chip. Certain home hobbies that use lead solder, such as making stained glass and jewelry, may be a source of lead exposure in home. Also, refinishing old furniture and woodwork that have lead paint may increase risk of exposure by air, dust, or paint chips. &sup4; You should discuss with your child’s pediatrician if you think your child has one or more of these opportunities to come in contact with lead. In addition, children who have come to live in the U.S. from another country should have an initial test of their blood lead level soon after arriving in the U.S.

References:

Children can have their blood tested for lead by consulting with the child’s pediatrician or the local health department. You can obtain contact information for local health departments in Michigan using an online map found here.¹ Many Michigan local health departments and other public health clinics offer free blood lead testing of children. For information about when to have your child’s blood tested for lead, see here.

References:

Additional resources