Frederica Freyberg:
Wisconsin physicians have new recommendations to test all children for elevated levels of lead in their blood. The state Department of Health Services is calling for universal lead testing for all one and two-year-olds and up to age 5 if not previous tested. The number of Wisconsin children who were tested dropped 75% from April 2019 to April 2020, according to DHS. Dr. Beth Neary is a retired pediatrician, adjunct assistant clinical professor of pediatrics at the UW School of Medicine and Public Health and copresident of the Wisconsin Environmental Health Network. She joins us to detail why these recommendations are needed. Doctor, thanks for being here.

Beth Neary:
Thank you for inviting me.

Frederica Freyberg:
How important is it that young children be tested for blood lead levels?

Beth Neary:
It is critical, and I’m really so proud of our state for taking this step. Right now, we have what’s called targeted testing, and as a result of that, we miss a lot of children. I don’t think we have a good handle on how many children in this state are being poisoned by lead.

Frederica Freyberg:
How concerning is it as the DHS reports that the number of children being testing has fallen off?

Beth Neary:
That’s extremely concerning. Part of it was COVID, because children weren’t going in to see their doctors but when you have targeted screening, you’re going to miss some children. When we go to universal, we’ll be able to find all of the children who are affected by lead.

Frederica Freyberg:
And what is targeted screening?

Beth Neary:
Targeted means you have a questionnaire, and if any of the answers to the question are positive, then you do a lead screen. Our previous targeted testing was based on the age of the housing. So we would capture, hopefully, children who were lead poisoned by paint, but we would miss children if it was lead pipes. If it was other things, such as living near a small airport that still uses leaded gasoline in small aircraft. We might miss children who had food that was contaminated, as with this last case we saw in November 2023.

Frederica Freyberg:
What happens to a child if they have lead in their blood?

Beth Neary:
Well, lead is a toxicant. It affects every organ in the system, but it is awful for the human brain. And if you think of children from the ages of zero to five, that brain is still developing. It’s creating these pathways, and it’s their future. So what happens is that it interrupts these circuits in the brain so the result is we see children who have lower IQ. It affects what we call executive function, and that means the ability to sit still in class, to regulate your emotions, to reason through things. So when you think about a child who can’t do that, and in kindergarten, maybe they can’t sit still and they can’t focus, they can’t learn, and so what we discovered is that if we had elevated lead levels in children, it affected their third grade reading and math scores. It affected high school graduation rates and it’s linked to incarceration. So it’s awful for the child, but it has societal implications for all of us.

Frederica Freyberg:
Is there any way to treat it if a child has elevated levels?

Beth Neary:
That’s a very difficult question. So once it’s in the body, the body sees lead as calcium, and so it gets stored in the bones. The only time we actually treat a child for lead poisoning is if their level gets up to 45 micrograms per deciliter, and that’s very high, and then they go through a process of what’s called chelation. They have to be hospitalized. It’s quite extreme, but the damage has already been done. It’s already hit the brain. Everything we should be doing is to prevent children from being lead poisoned.

Frederica Freyberg:
Speaking of doing things, should Wisconsin be doing more, particularly in Milwaukee, where two-thirds of elevated lead levels are found?

Beth Neary:
Absolutely. So what we do with blood testing is what’s called secondary prevention. What we really want to do is primary prevention. And what that means is prevent the child from ever being exposed to lead. So what we should be doing is taking the lead out of the environment, okay, and so we are doing some of those things. Getting rid of the lead service lines across this state, across the country, making sure that we have what we call lead safe homes. Maybe not lead free, but lead safe. The paint is in good repair. We have done wonderful things. We took the lead out of residential paint in 1978. We took it out of automotive gasoline in the ’70s and that was the biggest drop in lead levels for this country for children. What I would love to see is Milwaukee to say to all the landlords, show me that your property is lead safe before you rent it. Do you know what we do now? We wait until a kid is poisoned, then we go into the house and say, okay, now clean it up. That’s backwards. We should be preventing those children from being exposed, but we have a state law that limits it. Rochester, New York, has legislation like that. Baltimore, Maryland, does. We need to do that in Milwaukee.

Frederica Freyberg:
Dr. Beth Neary, thanks very much. Thanks for your passion.

Beth Neary:
Thank you.