HSM 
73-10011 
Lead paint 
poisoning 
in ehiidnen 
...a problem in your3 
eommuniry 9 lead paint 
poisoning in children 
... a problem in your community? About a year ago in Charleston, South Carolina, a woman 
with two small children who lived in one of the poorer neigh- 
borhoods began to worry because for a couple of weeks the 
two-year-old had not been his usual self. He was eating poorly 
and was not as alert and playful as he had been. She took him 
to the neighborhood clinic, where after a brief examination, 
the doctors told her there didn’t seem to be anything really 
wrong with him and that he would probably improve in a few 
days. 
A week or two later the child got worse, to the point that 
he was completely limp when she went to take him out of bed. 
So she took him to the hospital, where they did a more com- 
plete examination and then told her that the baby had a serious 
case of lead poisoning. They kept him at the hospital and be- 
gan immediate treatment. 
A couple of days later a nurse from the health department 
came to the mother’s home and found that the paint on the 
interior walls was very old and was chipping and peeling and 
falling to the floor. The mother told her that she had seen the 
crawling child eating bits of paint and slapped him for doing 
it and told him to stop, but admitted that she couldn’t watch 
him all of the time and didn’t think eating paint was serious 
anyway. 
After the health department nurse explained to her that 
eating paint chips was what had made the child sick, she asked 
the landlord to repaint the inside wails; when he refused, she 
moved to another house. 
The little boy came home from the hospital a couple of 
weeks later but he had suffered brain damage to the point that 
he could not talk as well as he had before and no longer had 
the full use of his arms and legs. 
He was so damaged, in fact, that after a few weeks the 
mother was persuaded to put him into a fulltime clinic for the 
retarded, where trained people could work to help him recover 
some of his abilities—even though it was probable that he 
would never recover completely. 
Today, the mother, who during this tragic experience 
learned a great deal about how lead-paint poisoning can 
occur among small children, is constantly telling her new 
neighbors about what happened and how they ought to be 
trying to avoid the same trouble. She says, however, “they 
don’t seem to understand what I am talking about and I don’t 
think they really believe me.” This is an actual story, typical of the experiences of 
parents of small children in other cities and not so typical in 
others. The story does, however, contain all of the elements 
of a situation that is now a national concern: the unaware- 
ness of parents about this danger to their small children, the 
lack of awareness of many physicians of the need to be on the 
lookout for lead poisoning, the unwillingness of some land- 
lords to repaint dangerous houses, and finally and most 
tragically, the permanent effect on many small children when 
they are exposed to peeling paint too long. 
When one reads the evidence that today more than two 
and a half million children under six years old live in housing 
where there is the danger of lead poisoning, it is reasonable 
to ask how and why this situation has happened—and what 
can be done about it. 
This threat to millions of children has been developing 
through the years from several causes. 
Forty years ago all house paint was manufactured with 
some amount of lead. The addition of lead made the paint dry 
faster and gave it a shinier and harder finish. In fact, the more 
lead the better and more expensive the paint, and some paint 
contained as much as 50 percent lead. 
Medical scientists, who had known for many years that 
lead could be poisonous when it got inside the human body, 
eventually began to speak out against the presence of so 
much lead in the everyday living environment of people. 
In response, about twenty years ago the paint manufactur- 
ing industry agreed to reduce the percentage of lead in paint, 
especially that used on toys, children’s furniture and for 
interior walls and woodwork. 
Although the efforts of many—but not all—manufacturers 
to reduce lead continued through the years, it was not fast 
enough to suit many public health officials and other con- 
cerned citizens. In 1970 Congress passed the Lead-Based 
Paint Poisoning Prevention Act; in August of 1972, the Food 
and Drug Administration issued a regulation directing that 
beginning January 1, 1973, new paint offered on the market 
could not contain more than one half of one percent lead. 
This did not affect, of course, the old paint—some of it over 
thirty years old—remaining on millions of walls. 
Through these same years another widespread change 
was taking place in our country. After World War II, or begin- 
ning about 1947, millions of Americans decided to move to the 
largercities and towns, away from smaller towns and farms. As the cities grew, many people in those cities moved 
out into the new suburbs, and some of their older houses, 
which had by now come to be known as “inner city,” were 
occupied by newcomers who simply were unable to satis- 
factorily maintain the dwellings. This was not true in all cases, 
of course, but today—twenty years later—the fact is that hous- 
ing experts estimate about seven million housing units in the 
nation are in a dilapidated condition. 
Translated to our concern about lead-based paint poison- 
ing, this means that a great percentage of those dilapidated 
housing units have interior walls with peeling paint or they 
are in such condition that the old paint—many layers of it— 
can be picked off in flakes or chips if a small child wants to 
do it. 
In some cases, interior walls or woodwork contained as 
many as ten coats of paint. And the lead content in the early 
coats is still there. 
Although cases of poisoning from eating lead-based paint 
chips have occurred in all kinds of houses in all parts of the 
United States, the biggest number of cases are being found 
in these millions of older houses in the larger cities. 
CHILDREN: 
How are they poisoned? 
Whether the house is in a large city or a small city or 
even a town, and whether the paint on the walls is ten years 
old or thirty years old, the two important factors are the 
presence of paint that can peel or be picked off and the pres- 
ence of a small child who can get to the paint. 
As the mother in Charleston says, it is hard to stop a child 
from eating paint if it is available. One physician who has been 
working on this problem in New York City for years says, “From 
the hundreds of cases we have seen, we have come to the 
conclusion that it is just too much to expect that a mother can 
watch a toddler all of the time. It is impossible for her to do 
that and get done all of the other things that a mother and 
housewife has to do.” 
Some children in the crawling and early walking stage 
also have what is known as “pica”, or a desire to eat non-food 
substances. Although it is not a disease but a tendency, the 
result is the same; they just want to put almost anything they 
can pick up in their little mouths. And unfortunately paint 
chips have a sort of sweet taste, making them more attractive 
than some other things around. Putting these two factors together—the inability to watch 
small children all of the time and their possible inclination to 
eat non-food substances, it is reasonable to say that even if 
all of the babysitters—mothers, fathers, brothers, sisters and 
friends, KNEW about the dangers of eating paint chips and did 
a good job of supervision, they still wouldn’t be able to prevent 
the children from eating, if paint was available. That is why 
health officials working in the field are emphasizing that the 
job is to find susceptible children AND remove the hazard 
from the home. 
Scientists have established the amount of lead that a 
human being can take into his body without harm—very small 
amounts will go through the body and out again. But a paint 
chip the size of a fingernail contains almost 100 times the 
amount that should be consumed in one day. If a child eats 
an average of three fingernail size chips a day for several 
months that is enough to cause sufficient lead to accumulate 
in the body to make that child sick. And lead is accumulative; 
the more the child eats the more serious the effect. 
What is being done? 
Health officials recognized years ago that any serious 
attempt to do something about this problem would require 
an organized effort to find those dwelling places where paint 
was peeling and children were living, to set up clinics where 
suspected children could be tested and to persuade parents 
to bring the children there, to be sure that children were 
treated when it was necessary, and to make the living places 
safe for the future. 
Some cities, Chicago and Philadelphia, for example, 
have had organized programs in the Health Departments and 
Housing Offices for at least five years. 
When Congress passed the Lead-Based Paint Poisoning 
Prevention Act in 1970, it enabled the Federal government 
for the first time to give active assistance to many cities ready 
to begin an effort to find and treat children with high blood 
levels of lead. 
Under this Act, the Department of Health, Education, and 
Welfare’s Bureau of Community Environmental Management 
has provided funds to 40 cities to start or expand efforts to 
prevent lead-based paint poisoning. 
These cities, large and small, and in all parts of the United 
States, range from New York and Los Angeles, where there are 
hundreds of blocks of dilapidated housing, to smaller towns like Nashua, New Hampshire, where the task of finding 
susceptible children and correcting the housing problems are 
somewhat different. 
In addition to the 40 cities which have Federal grant funds, 
perhaps a dozen others have started programs, either in the 
Health Department or the Housing Inspector’s office or both. 
And 30 other communities have indicated their desire to start 
a lead poisoning program as soon as they can generate public 
and official interest enough to allocate funds. 
In the 40 cities with Federal grants, by the end of the first 
full year of operation of the programs, more than 400,000 chil- 
dren will be screened and tested. 
Even more importantly, the experience of the 40 cities— 
each different in makeup and each approaching the problem 
differently—will provide lessons of experience that will make 
the task easier for others planning to start soon. 
Some lessons have already been learned. One experi- 
enced worker says, “The first thing you need to begin a good 
program of prevention is a commitment by the community at 
large to do something about this tragic problem.” 
This means that the leaders of the community—public 
officials, health officials, and the civic leaders, as well as 
leaders of the poorer parts of the community where dilapidated 
housing usually exists—must be aware of the nature of the 
problem. 
If the awareness is sufficient these are the people who 
will work to seek the means to do the job; they will help get the 
funds to organize the workers to find the children, to set up the 
facilities to test the children, to arrange for necessary treat- 
ment and to help correct the dangerous housing conditions. 
Getting the word out 
Most community programs begin by sending employees 
of the health department or the housing office into the neigh- 
borhoods where dilapidation—and peeling paint—is likely. 
These employees are usually known as “outreach” workers; 
in some cases they are volunteers, often people from the same 
neighborhood. 
In a few cases the health departments have asked all city 
workers who may go into dilapidated neighborhoods for 
various reasons, like social workers or men from the housing 
department, to keep an eye out for signs of peeling walls or 
woodwork. 
The problem must be explained to the mother or both parents of small children. Outreach workers have learned that 
the process of explanation must be a careful one; they aren’t 
there to scare the daylights out of the parents, and neither can 
they allow the parents to get the impression that it is being 
hinted that the parents are not taking good care of the chil- 
dren. It must be made plain that this is a problem recently 
discovered to be a widespread hazard and that many people 
of all classes are unaware of the danger. 
It must be explained that sometimes loss of appetite or 
vomiting or general listlessness, which could be taken for a 
virus infection or upset stomach that will disappear in a couple 
of days, can really be signs of lead poisoning. 
Then the outreach workers must convince the parent to 
have the child tested. It is not enough to accept the assurance 
of the parent that he or she will sweep up the paint and keep 
the house clean from then on. If there is real evidence of peel- 
ing paint then it must be explained to the parent that symptoms 
of illness may not be obvious, that a free blood test is the only 
way to be sure the child has suffered no damage. 
In most cities with active programs special clinics are 
set up just to do blood tests for lead. In some programs the 
public health nurses take their testing equipment right into the 
homes where parents have agreed to have their children 
tested. And if the first test indicates that the child may have 
too much lead in the blood, then it is usual to do a second 
test a few days later to be sure. 
During these screening and testing programs, most com- 
munity efforts have been accompained by a public education 
campaign to explain them. Although newspaper publicity, 
radio and television announcements, and word of mouth 
efforts do not always reach all of the people that should 
be aware of the danger, they do help a great deal to make 
the general public aware of the problem—and experienced 
workers agree that general public support is important. 
These old hands in the lead-based paint program also 
say that in their experience the support of the general public 
is always freely given when there is understanding of the prob- 
lem and of the potential tragic cost to the future of the com- 
munity’s children. 
In many cities volunteers—especially teenagers—have 
been helpful in this aspect of the program. They bring en- 
thusiasm and a commitment that often overcomes difficulties. 
In New York City they tell the story of one teenage girl 
who decided to work on lead poisoning on her own, without tieing into any organization. She even went to the Health De- 
partment’s Lead Program and persuaded a physician to come 
with her to every home on her block. They did find a child 
with an elevated blood level and the physician quickly put 
the child under treatment. A housing worker followed with a 
test of the child’s home, but when he found no trace of peeling 
paint, he closed the book on the case. This didn’t satisfy the 
teenager, so she went back and talked to the child’s mother 
again and got out of her the information that the child was 
often left in care of her grandmother, who lived in another 
block. The teenager visited the grandmother and discovered 
not only that there was peeling paint in this house, but the 
grandmother also did babysitting for half a dozen other small 
children. The physician tested these children and found still 
another case of elevated blood lead. 
When the outreach workers, or the nurses, have done their 
testing and established that a child shows a level of lead in 
the blood that is higher than normal, they notify the physicians, 
and treatment of the child can begin immediately. 
It is at this point that the true value of screening programs 
demonstrate their worth. The physicians can explain very 
simply that the lower the amount of lead in the child’s blood, 
the easier is the treatment. If the child has only a small amount 
of lead in the blood over the accepted minimum, then treat- 
ment is simple; it can probably be done with a few visits to the 
clinic. If the amount of lead is higher the child may have to be 
hospitalized for a few days. If it is very high, then a couple of 
weeks of hospital treatment may be necessary. 
The point to be made clear, the physicians say, is that the 
quicker they find the child who has been eating paint chips 
the better; the sooner they can begin treatment the greater his 
chances of total recovery. 
The housing aspect 
In addition to finding and treating the child, the other side 
of the prevention program is equally important—eliminating 
the old peeling paint in his environment. 
When outreach workers find a child with a high blood level 
and get him under treatment, their next step is to notify the 
housing office. An inspector from the housing office visits the 
child’s home to check the dwelling for a determination of 
whether or not the peeling paint is in fact the cause of the 
child’s illness. Their usual method is a meter that can be 
placed up against the interior wall to measure the amount of lead in the paint. 
If the paint is not the cause they can begin other steps 
to find out what is; but if peeling paint is the cause, then they 
can help with suggestions about specific steps to eliminate 
the paint hazard; the child will no longer be subjected to the 
danger. 
In the great majority of cases where children had high 
blood levels, the family lived in rented housing. The means and 
methods for persuading the landlords to remove the dangerous 
paint and repaint vary widely from city to city—and are a major 
consideration for any city planning to begin a campaign. 
Some cities and towns have ordinances to force the land- 
lord to remove the hazard upon certification by the housing 
authority. In others, the health or housing department must 
go to court to force repairs. In still others, the health depart- 
ment has asserted such a strong, moral position about the re- 
moval of health hazards to small children that the landlord 
usually complies—even without the authority of an ordinance. 
Each city planning a lead-paint campaign must be knowl- 
edgeable about the specific legal authority it has to work with 
before the campaign begins. In any case, they must reckon 
with the probability that landlords are not eager to spend 
maintenance money that they can avoid. 
The Director of Housing for the City of Chicago, which 
has had a very active program for five years, estimates that 
if the repainting of a house is done by a contractor the cost 
averages $400 a room, which includes scraping off all of the 
old paint and completely repainting. In other cities the esti- 
mates are about $200. 
THE HOME: 
What can parents do? 
It is here that campaign leaders in many cities and in 
the Federal effort hope that they can have a real effect with a 
strong educational campaign—with emphasis on the word 
“prevention.” 
Even if the child is tested and found to have a low level of 
lead in his blood, and even if there is very little peeling paint 
in his house, there is a great deal that the mother, or both 
parents, can do to assure themselves that their child will 
always be safe. 
At the very least, the mother or the babysitter ought to 
keep the floor swept clean all of the time, so that there is 
no possibility the child can find stray paint chips. Next, she ought to look around to find paint that might be 
pulled off by her child and then either brush the loose paint 
off with a broom or a strong brush. 
If she can go further, she and her husband can sandpaper 
or scrape down the walls to get off all old paint. Even if they 
do not believe they can manage to repaint with unleaded 
paint any time soon, the child is better off picking at bare 
woodwork than picking at old paint. 
If they can, of course, they ought to repaint the interior 
walls and woodwork with lead-free paint—but not until the old 
paint is off. There is no point in repainting with new paint on 
top of old paint; the new paint can still peel and the old paint 
is underneath and available to the child. 
If parents cannot repaint all of the interior walls, they 
ought to repaint up at least four feet from the floor, which is as 
high as a toddler can reach. But in that case they ought to be 
sure to make a regular check on the walls above the four-foot 
level to be sure that peeling paint is not dropping to the floor 
from that level. 
In the months and years ahead, cities who plan to begin 
campaigns to prevent lead- paint poisoning will be able to get 
technical help, even if Federal funds for the whole campaign 
are not available. For example, the Department of Health, 
Education, and Welfare has established a National Clearing- 
house on Lead-Paint Poisoning Prevention in the Health Serv- 
ices and Mental Health Administration in Rockville,Maryland. 
The Federal government is also doing research to improve 
and simplify screening and testing methods, treatment meth- 
ods, and other aspects of the whole effort. 
But the 400,000 children that have been screened and 
tested, and the many thousands that have been given treat- 
ment, are only the beginning of the job to be done. Last year 
it was estimated that 600,000 children showed blood contain- 
ing too much lead; 125,000 of these may have had lead poison- 
ing. And about 6,000 suffered neurological effects, including 
mental retardation, like the child in Charleston. 
Public health workers in the Federal government, the State 
governments and in hundreds of cities and towns are con- 
scious that the problem is clearly visible, that the methods 
for elimination of this threat are available, and that the goal is 
clear. All we need to do is commit ourselves to what is neces- 
sary to protect the lives and health of these small children 
who cannot do for themselves. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 
Health Services and Mental Health Administration 
Bureau of Community Environmental Management 
DHEW Publication No. (HSM) 73-10011