Prevención de la exposición infantil al plomo en el agua y la pintura

[En inglés]

Preventing Childhood Lead Exposure

Melissa Lin: On today's webinar, we are pleased to have Michaela Horn presenting. Later in the webinar, Steve Schuman from the National Center on Health, Behavioral Health, and Safety will be moderating the Q&A. Now I'll turn it over to Michaela. 

Michaela Horn: Thank you, Melissa. Hello and welcome to this webinar on preventing childhood-lead exposure from paint and water. It was much fun to see all of the different locations popping up in the chat. It's good to see so many people joining us today. 

A little bit about me. I'm Michaela Horn. I have been working in public health for 30 years. The majority of my career in public health has been with a focus on health and safety in early learning environments. I have this desire to make sure that children get the very best start in life, to learn and to grow, and part of that is protecting them from environmental harms. 

For the past 26 years, I've worked as an environmental health specialist and child care health consultant for a local health department in Washington State. I do education and consultation to early learning providers in the county where I work. I'm an environmental health specialist with a bachelor's degree in environmental health and a master's in toxicology. 

I'm very excited to have this opportunity to share some information with you today about childhood lead poisoning prevention, and to go over some simple, but important things you can do in your Head Start and early learning programs to reduce children's exposure to lead. Let's get started with some learning objectives. 

In today's webinar, you will learn how to understand why lead is a concern, to learn where lead can be found in the early learning environment, to know how and when to have the water in your facility tested for lead, and some steps to take if lead is found. We're also going to spend some time here talking about lead in paint. At the end, you will get some guidance about how to develop a plan for your facility to prevent lead exposures and engage in best practices. 

We've known, for a long time, that childhood exposure to lead is harmful, but it's been more recently that experts have recognized just how low of a level can cause that harm if it's in a child's blood. In fact, no safe level of lead has been identified in blood lead levels for children. 

It's only when we understand how children can be exposed to lead, that we can take the steps necessary to protect these children from it. As we get started today, I want to start with a little poll. It's nice to get an idea of who has joined us. Please take a minute and share with us your role. What you do. 

It looks like there's a lot of health services staff, managers, and directors. A lot of different roles. If your role is not listed, feel free to share that in the chat. Facilities, maintenance, child care, health consultants. Great. It's wonderful to see a wide variety of people here, and I hope that each of you can find something, in this webinar, that is helpful to you. I think we're slowing down with the poll. Great. OK, so let's get started. 

We're going to start with some background information on lead. For some of you, maybe this information is a review, especially since lead has been in the news a lot more often the past few years with a push to improve some of our water infrastructure, with a couple of recalls that have happened for applesauce or cinnamon products. For some of you, this may be new information, it's really good to all get on the same page to start with. That's what we're going to do. 

We're going to start with what is lead. Lead is a naturally occurring bluish gray metal. It's toxic to people, even in really small amounts. It's mined from rock or, kind of, like the rock in this picture, which is galena. Some of its most known historical uses were in paint, in plumbing, and in gasoline. 

In paint it helped the paint be more durable and stand up to the elements. It also helped enhance its color, making it really bright white or yellow or red. It helped the paint to dry faster as well. In plumbing, it was used because it's soft. It could be formed into all the shapes needed to make the pipes that move our water. It's also durable and it was resistant to corrosion; it lasted a long time. 

In gasoline, it was found to reduce noise, engine knock noise from the engine and it was added. But as people became more aware of the toxicity of the metal, steps were taken to ban its use. We found out it was bad; we started to ban it. 

Lead paint in the United States was banned in 1978, so housing or buildings built before that may contain lead paint. The use of lead in plumbing pipes and solder was banned in 1986, although there are some caveats to that, and there may be lead even in some newer things. We'll go over that when we get to that section. 

We finally officially got rid of leaded gasoline in 1996. Steps were taken earlier to start getting rid of gasoline leaded gasoline but, even today, we still have some lead in our aviation fuels it's still an issue. The problem is that once lead is in the environment, it tends to stay there. 

Lead can leach from plumbing into the water. It can chip and flake from paint as the paint gets older. The lead from gasoline that was used years ago remains in the soil along roadways. 

Children get exposed to this environmental lead. They get exposed in two main ways either ingesting it or eating it or inhaling, or breathing it in. Ingestion is the most common route of exposure for young children. It comes from eating contaminated food drinking contaminated water. 

Children exploring the world through their mouths. They ingest it when they get it on their hands, or if it's on other surfaces that they put in their mouth. These little bits of lead are so small we can't really see them, but they're still enough to cause harm. 

Inhalation or breathing in of lead dust is another common route by which kids are exposed. Children aged 6 and under or under the age of six are most at risk of exposure to lead and the adverse health effects that result. Some of the reasons for this, like I just mentioned, they have a lot of health, hand-to-mouth behavior. That's how they're exploring their world. That also puts them at risk. 

They're closer to the ground, their breathing zone is close to the ground and they play on the floor. This is where there can be higher concentrations of lead dust. Their bodies are still developing. Their brains, their nervous systems are changing very rapidly and so lead can have a greater effect. Their bodies actually absorb a higher portion of the lead that they ingest than, say, you or I or an older child, even. 

You or I may absorb 10% of the lead that we're exposed to, but a very young child, they can absorb half of the lead that they're exposed to. It's also really important to note that there is no safe level of lead in a child's blood that has been and identified. Next slide, please. 

Even a very small amount of lead can harm a child. The majority of children who we find through our work at the health department, looking at children with elevated blood lead, a lot of them are asymptomatic. That means that they look and generally act healthy. We don't see the outward signs. What's happening to them is a lot more subtle. 

Lead causes damage to the brain and nervous system. It causes delays in a child's growth and development, including their bones, their muscles, various organs. It can affect a child's cognitive ability or their ability to learn lowering IQ. It can affect their behavior, such as their ability to pay attention can cause hyperactivity. It can result in difficulties with hearing or with speech. 

All of these things together, that can affect a child's ability to perform well in school, even as they get older. These higher exposures to lead can eventually lead to damage to various other body systems like the heart or cardiovascular system, kidneys, and the reproductive system. That's a lot of bad news. 

The good news is that childhood lead exposure is preventable, and we know how to do it. We're going to spend the rest of this time together going over ways that you can make sure that the children in your care are protected. 

We're going to start with some of the Head Start Program Performance Standards and what they say. I know some of you may not be with Head Start programs, you might be with other early learning programs. Most of the information presented here is relevant to any type of early learning program. 

What will be important for you is to look into what the child care early learning rules, in your location, I saw people from all across the continent, what do the rules say for your specific area about exposures to toxic substances or lead specifically? To assist you, in the chat there was a handout placed in there. That handout is going to be your guide for all of the links and all of the resources that I'm going to share with you. They're all listed there. 

There is a link to a national database of Child Care Licensing that you can look up whatever the rules are for your state, territory, or your tribe. Do refer to that handout. 

The Performance Standard states that all facilities where children are served must be free from pollutants, hazards, and toxins that are accessible to children and could endanger a child's safety. That's a really broad statement. Lead is included in that statement. Clearly, it's very important to keeping children in Head Start and early learning programs healthy. 

There's also an Updated Performance Standard that gets a little more specific. To prevent lead exposure, programs need to develop a plan to prevent children from being exposed to lead in water and paint. Each facility is really different, and so each plan that is created is going to be different. I'll give you a little more information about things that can go into your plan in a bit. 

Paint and water are also specifically called out here. All the other sources of lead that exist, they're still covered in that previous statement of having a place free from pollutants, hazards, and toxins. In facilities where lead might exist, a program must conduct testing and have an inspection by a certified professional at least every two years. 

Let's pull this apart just a little bit. It says that in places where lead might exist. How do we know if lead is there? Remember, we can't really see lead specifically. If your building was built before 1978, lead paint may have been used. You need to assume that it's leaded paint unless you've had it tested and the no lead exists. 

On the other hand, if you've got a really new building built in the last few years after lead paint was no longer being used, you don't need to worry about the lead paint part of this. Likewise, if your water pipes are from 1986 or older, there's a good chance they have some lead in them. Even some newer fixtures could contain lead. Having the water tested, seeing if anything's there, testing every two years. Appropriate, we're going to go into a lot more detail about water testing. 

Then the Performance Standards states that if it's needed, that you need to remediate or abate to prevent lead exposure. Remediation means controlling the risk, making things less risky. Abatement is permanently eliminating the lead hazard. These two activities should only be done by lead-safe certified professionals. We'll go into how it's one of those professionals a little bit later. 

First I want to start with lead in drinking water. In this part we're going to cover how lead gets into the water, how to know if it's there and what steps to take if a test result comes back showing that lead's there. If you take a minute and look at this child drinking some water from a water fountain, there's no way to know if there's lead in that water. 

We can't see it, you can't smell it, and you can't taste it. The only way to know if there's lead in that water would be to get the water tested. How would that lead have gotten into the water in the first place? 

On the next slide there is a graphic. This graphic comes from the US Environmental Protection Agency and it shows a house. The same principles are going to apply to early learning centers or other buildings that get their drinking water from a public water supply, or even from a private well. 

Lead isn't typically found in the sources that we get our drinking water from, like the rivers or the lakes or the groundwater. The water from these sources goes to the water treatment facility, and then it goes into these water main lines and gets delivered to all of us. Sometimes the water goes from a well and goes directly into the building from there. 

Inside the building, it passes through a distribution system to get to all of our fixtures. It's here where a lot of these fixtures could either contain lead or be joined together with lead solder. It could be the pipes; it could be in the faucets and the fixtures. 

It could also be in the water line that goes from the water main line to the building. That in certain places was commonly made of lead. Some of these are being replaced, some of them have yet to be replaced. All of these faucets and fixtures and pipes that are inside of our buildings, if they were made before the year 2014, they could have lead in them. 

In 1986, lead was banned in plumbing systems. You're only allowed to, at that point, use things that are considered lead free. What was considered lead free in 1986 is different than what was considered lead free in 2014, when the Reduction of Lead in Drinking Water Act went into effect. That act changed the definition of lead free to a much lower level than was previously established. 

A good rule of thumb is if your fixtures and plumbing are older than 2014, there's a pretty good chance that lead could be there. If it's older than 1986, definitely need to get your water tested. Another thing is, over time, the metal in pipes can corrode. It can become weakened or damaged. This is more likely to occur if the source water is acidic or doesn't have a lot of natural minerals dissolved in it. 

Over time, this problem can get worse. If water sits in the pipes for a longer period of time, more of it can get into the water. We do need to make sure that we are testing. That's the way that you're going to know if water from these pipes and fixtures gets into your drinking water. There's other sources of water quality information out there. 

There's your water utilities have something called a water quality report. That's a great way to know about your water, but it's not a great way to know if your water has lead in it, because the lead is coming from the plumbing and pipes and fixtures in your building so that water quality report is not going to tell you about your fixtures. 

Likewise, the plumbing in every single building is different, you can't rely on water tests from your neighbors or a neighboring building. You actually have to test every faucet and fixture in your building from which you get water for cooking, drinking, making baby formula for consumption. You will also want to make sure you include anything like an ice machine, water fountains, bottle filling stations, water bottle filling stations. 

Test all the faucets you use for these purposes. Each fixture in your building may also be different. They may have been installed at different times or in different ways. They can be connected to different pieces of pipe, you don't have to test fixtures or faucets used for hand washing only, or your janitorial or custodial sinks those that are used for cleaning up after art projects, just the ones where you get water that you're going to consume. 

All samples need to be sent to a laboratory for testing. You'll want to find a certified laboratory that is certified by your state or area to do water testing for lead. On that resource handout that I mentioned earlier, you will find a link to find labs in your area that are certified to do this. 

There are some over-the-counter or mail in tests that you can buy do it yourself type of tests, but these are not accurate enough to use in an early learning setting. As for frequency, you need to test every two years. 

If your water utility is doing a really good job at controlling the corrosivity of the water, even if you have some lead in your pipes or fixtures, it may not be leaching into the water. But if something changes over time, you need to be testing frequently enough to know that change has happened. 

The Head Start Program Performance Standards also gives you a little bit of leeway. If you know that you've had your building re-piped and that there is no lead present, or if you're only using bottled water, you wouldn't need to be testing. For more specific guidance for your particular facility, your local health department is always a really good resource for advice. 

Let's look a little bit at what the steps are needed for water testing in early learning programs. The first step is to find a certified lab to work with. You will find your lab and you will get some information on testing and pricing per sample, how they process the samples. 

You'll also want to ask how you're going to get the bottles, how you're going to return the bottles, and how long it takes for you to get the results. There are some programs operating right now through a federal program called the Wynn Grant, and that's water infrastructure for the nation grant. Some of these programs are providing free water testing or low-cost water testing for childcares and schools, early learning facilities. Do check if your area has a Wynn program running, because that may be a good way to get these tests done. 

The next step is to look at your building and make a list of all the faucets and fixtures in your building for which you get water for consumption. Don't forget all your classrooms, your kitchen, the gym, the common areas, water fountains may be inside or outside, ice machines. 

In a home, if there's any parents there or facilities operating in a home, you may only get water to drink from the kitchen sink then you would only have one. In some of the bigger facilities, you may have many locations. You'll want to make sure you give each faucet or fixture a unique name so you know which sample came from which water faucet. You might have classroom 101 sink A and then sink B. Making a drawing can be helpful. 

It's a good idea to label any sinks that you don't want people drinking from, that you're not going to test. Put "Do not drink" or "Not for human consumption" signs by your handwashing only sink in the bathroom or your custodial sink. 

The next step will be to collect your samples. You'll have to choose a date to do your sampling. You want to find a time when the water can sit in the pipes overnight for at least eight hours, but no more than 18 hours. Over a weekend is not going to work, just generally overnight. 

You want to make sure that no faucets are leaking or dripping, because that's causing water to move through the pipes, and you want that water to sit in those pipes for a little while. If you share your building with others, make sure that they know when you're going to do this testing and not to use the fixtures during that time. No flushing toilets or running opening taps during that time until after you've come in the building in the morning and taking your samples. 

When you take the samples, you'll want to collect the first draw water. That means you're getting that first bit of water that comes out of the fixture. You'll want to make sure you're using the cold water when you do this, and you'll want to put the bottle underneath the fixture before you turn on the tap so you're catching that first bit of water. Don't remove the aerator. Take the sample as if you were going to fill up a glass for drinking from. Fill up your bottle, and there's usually a line on the bottle showing how high to fill it. 

Once you've filled up all your bottles, make sure you know which bottle is from which faucet. Label them to match that list that you made earlier and make sure that the names match. The lab may also provide you with what's called a chain of custody form that you'll fill out when you send in your samples. Then you will take or send your samples to the lab for the testing and wait for your results to come back. 

There is a lot more information on specifics for how to test. Again, every building is going to be different. On the next slide, I want to share with you a really great resource that will answer a lot of questions. The US Environmental Protection Agency has put together this resource called the 3Ts program. It is for water testing for lead in schools and child care facilities. 

3T stands for training, testing, and taking action. In this resource, there's a lot of information. Step by step how to take a sample, how to determine which faucets and fixtures to test. There are how to videos. There's even a comic-style guide how to take samples and a lot more. 

This resource is also listed on your resources handout; I would refer you to that for your specific questions. Also, remember your health departments are there to help as well. 

The Head Start website has two new resources that can also be very helpful. One gives simple guidance on how and when to test for lead, and the second talks about what steps to take if your water test comes back, showing that there is some lead in the water. Those links are also on that handout. 

Next we're going to look at some of the information from that second handout. "What do my results mean?" and "What do I do about them?" Ideally there should be no detectable lead in your early learning programs drinking water. That would be ideal. That's the EPA'S goal as well. No lead. 

If your lab slip comes back with the letters ND on it, that stands for not detected. It means that the level was either lower or the level was so low the lab was not able to detect it. That would be ideal. Unfortunately, that's not always the case. Sometimes the lab will report a number greater than zero. Those numbers are reported in parts per billion, which is abbreviated ppb, or it might be reported in micrograms per liter, which is a little ug symbol over l. 

If other units are used or you don't understand the results that come back, don't hesitate to reach out to the lab to help you interpret it, or to give you the results in a different format, like in parts per billion. Health departments are also really helpful for that. 

Check with your local and state requirements. Remember that there's no safe level of lead. We ideally want zero parts per billion. The EPA has something that's called an action level. The action level is where you really water facilities, water systems need to be doing something to reduce the amount of lead. Currently, that is at, I believe, it's 15 parts per billion. 

There are a lot of school and child care regulations across the US, that use a lower action level than that. Maybe it's five parts per billion. Some are even lower than that. Make sure that you look at what your state or local regulations are and always go with the most protective level. 

If there's any measurable level of lead in your drinking water, your goal is always going to be to reduce it as much as possible. If the level is higher than five parts per billion, best practice is to not use it until you've taken steps to reduce the level. In the next few slides, we're going to go over some ways to do that. There are short-term solutions and long-term solutions in how to get rid of the lead. 

It's helpful sometimes to get help from your local health department or maybe even a private consultant to decide what action steps to take to reduce the lead. One strategy used by a lot of people is flushing the pipes. This means when the water sits in the pipe for a long time, that lead level builds up. If we then let that water that's been sitting in the pipes overnight out, or if it's been sitting in there for four or five hours, let it out, then the water lead level should be lower. 

That means turning on the water when you get into your building in the morning, letting it run until it's noticeably cooler. Often this will be like 30 to 60 seconds, but it can vary a lot, and it'll vary per building. You should always flush your fixtures before you use that water for drinking, cooking, or making baby formula. 

It's also important to use the cold water and not the hot water. I know it might be a little faster to fill your pot that you're going to make noodles in with hot water, but it's safer to use only the cold water. Remember that boiling does not eliminate lead. 

It's also important to routinely clean the aerator. That's the little screen attached to the end of your faucet. Unscrew it and clean it, because little, tiny pieces from the deteriorating plumbing or the solder may get stuck in there and add to the amount of lead that comes out of the tap. Clean that regularly. 

Another source of lead or another way to reduce the lead is to potentially to replace plumbing pipes or fixtures. Here you definitely want to get some professional advice. Usually to figure out if their specific lead pipes or fixtures, you'll want to take additional water samples, and there's some tricks to how to do those different types of samples. There's also some visual inspections that can take place to help identify lead pipes, or pipes that could contain lead. 

I have just an example. We had a childcare that had I don't know, 15 or so different fixtures that they tested. Of all of those fixtures, only one came back having any detectable lead in it. That facility replaced that one fixture, and then all of their samples came back with no lead in it. Again, it's going to really vary from place to place. 

You could also choose to take the affected fixture out of service and use a different one that tested lower or tested with no lead. Some facilities also choose to purchase bottled water and some will choose to use a water filter. My next slide talks about water filters. 

The EPA again has a really excellent resource. There's a lot of different types of filters on the market that could be used. Some of them attach under your sink, some of them attach to the faucet itself. Some of them are countertop pitchers or canisters that you fill up. This is a very common way to reduce lead in drinking water. 

If you choose to use a water filter, you'll want to make sure that you're using one that is certified by an independent third party. There are certification marks on the filters that you'll want to look for. This handout, which is also linked to on your resource sheet, has what those certification marks look like so you'll know what to look for when you're buying one. 

When you're using a water filter, you want to make sure you're following all the manufacturer's instructions, and that the cartridge is installed correctly. You'll also have to change that cartridge regularly. How often you do so is going to depend on how much water you filter every day, how many kids you're serving, how big your classroom is. You'll have to do some calculations. Figure out, based on the manufacturer's instruction, how often you'll need to do that and then make sure that you're budgeting for buying those replacements. 

Remember early on we talked about that you'll need to develop a plan to prevent children from being exposed. What is included in that plan? You'll want to keep records of all the testing results that you've done, keep them in one location, and write down what you found and what you've done to remedy that situation. Whether you've chosen to use bottled water, whether you opted to use a filter, whether you flush your pipes. Those things need to be written into an actual action plan. 

Incorporate procedures into your normal operating procedures. Set up routine checks. As an example, let's say you chose to use a pitcher type water filter. You'll want to make sure that you change that filter regularly. You can put that on a maintenance checklist or even post a little sign near where you keep that filter saying when it needs to be changed next. 

You'd add to your policy that you're filtering your water to protect children from lead using a certified filter that you change the filter cartridge, let's say, every three weeks is what you've decide. That you're cleaning the faucet aerator every time you're changing that filter. That you're going to continue testing the water every two years using a certified lab. 

The National Center for Healthy Housing has developed some really comprehensive checklists that can be used. Again, the link is on your resource sheet. They have a version for center-based care and then they have another version for home-based child care. 

They also have sample lead safe policies and worksheets with action steps. Feel free to use the information on these to help develop your plan. Make sure that the plan matches your facility, your facility’s needs, and what you do at your facility. 

Always communicate your test results with families. If families have concerns, encourage them to speak to their child's health care provider about blood lead testing. Don't hesitate to reach out to professionals at your water utility, at your local or regional health departments, and to help determine what action steps are best for your facility. 

Now, I want to switch gears for a minute and talk a little bit about lead in paint. The buildings that your programs are housed in are going to be extremely varied. Take a minute and think about your specific building. Do you have are you part of a larger child development facility? Do you have a classroom in a K through 12 school? Are you housed in a church or a community center? Is your program residential home based? You're a parent, think about your own home. 

Let's take a little quick poll question for everyone. How many of you actually know when the building that your program is in was built? Maybe if you're in a home, you have a pretty good idea. Maybe if you're in a commercial building, you have absolutely no idea. Looking at the poll results coming in, it looks about half of you, a little less than half knew exactly the year your building was built. A lot of people have no idea, that's what I typically find when I ask people this question. 

Having this information is really helpful in trying to figure out if lead paint may be present. If you have no idea, there are ways to find out through your local assessor's office, through your building management companies, see if you can figure out when you're building was built. 

Many homes and buildings were built before lead paint was banned in 1978. The older that a building is, the more likely it is to contain lead paint. This image here shows when lead paint was more commonly used. 

Houses built between 1960 and 1977, about one out of four, has some lead paint in it. When we get to the older buildings, those built 1940 to 1959, 70% almost have some lead paint. Housing built before 1940, the vast majority contains lead paint, so that can give you some idea if you generally know when your building was from. 

The problem is that when paint isn't maintained in good condition or just over time from wear and tear, the lead paint can flake or chip off. Kids put things in their mouths, we already said that. Paint chips actually kind of have a sweet taste to them, so that makes them pretty attractive to little ones. 

On some surfaces, paint wears down a little more subtly, like on window and door frames, where they get rubbed when they open and close, or porch surfaces that get walked on. This creates a lead dust that you can't really see, but settles on horizontal surfaces, but that dust may be enough to poison a child. 

Lead can be inside and outside. It can be used on different types of buildings. There is a really great handout on lead in your home that is produced by the EPA and Consumer Product Safety Commission, and Housing and Urban Development. That link is on your sheet as well. 

If your building was built before 1978, you either should test to make sure you know if lead is there or not. If you're not testing, then you need to assume that lead paint is present and treat it as if it does. 

Testing needs to be done in older Head Start facilities, and we'll talk about how to find someone to do that testing in a minute. It's important to keep the paint that you do have in good condition. Intact paint on walls doesn't pose a risk. It's when the paint flakes or chips or deteriorates creates that dust that it can make kids sick. 

Look at your painted surfaces on a regular basis. That should be part of your plan. Check them for signs of damage or signs of moisture. Moisture can make paint come off of walls. Keep a record of when you did these checks and what you saw. Dust horizontal surfaces regularly with a damp paper towel and mop floors with a damp mop that collects the dust rather than just spreads it around. 

If you have carpeted floors, use a vacuum that has a HEPA filter on it. Also, be careful about soil tracked in from the outside. It can have lead from outdoor paint in it or from roadways. A good quality walk off mat takes a lot of the stuff off of our shoes, have a really good quality mat outside the door where you come inside and have people wipe their feet. That's a really simple thing you can do to minimize exposure. 

Whatever things you do to reduce kids exposure to lead take and add those steps to a written plan. This includes all the maintenance steps, any test results, any reports from professionals. Remember that if you had your facility tested, keeping all those records and reports, showing what needs to be fixed, and keeping documentation of what you do to remedy the situation. 

If lead was identified, make a note of the date that you can remember to have another inspection in two years. If there are repairs that need to be made, those have to be done by a trained professional. If you notice during your routine, check that your paint in an older building is starting to chip or to flake, you'll want to consider getting that fixed. 

All of those renovations, or if you're getting new windows or repainting old walls, those things in a child-occupied pre-1978 building where there might be lead, they have to be done by a lead-safe, certified professional. These people are trained to know how not to create lead hazards and how to properly clean up areas before kids are allowed back into those spaces. 

To find one of these EPA certified lead inspectors, risk assessors or contractors to do the work, there is a website epa.gov backslash get lead safe is the link. There are links to these websites on your resource sheet. 

On the next slide there is a brochure, also linked on that sheet, that gives a lot more information about how to renovate or do work correctly, and what these contractors need to be doing in childcare, schools, and other early learning programs. 

I would love to give you more specific information, but it's dependent on your facility that, your best bet is to look at some of these resources to get the testing done by a certified lead inspector and follow their guidance as how to remedy the problem properly. 

That was a lot of information, and I know it went by pretty fast. I would love for people to share in the chat what is one thing that you could do today, at your site, to reduce children's exposure to lead in paint or water? Maybe it's something you're already doing, maybe it's something that you could start doing. Go ahead and put in the chat some things that you could do. 

I see a lot of good ideas in there. Finding out when you're building is built, morning flushes for the drinking water, following up on testing, using doormats, filtering water, looking out for chipping paint, vacuuming with a HEPA filter. Great. Lots of great things in the chat. Thank you for sharing. 

I would like to share one more thing before I close, and hopefully I'll have a little bit of time at the end for a few questions. I want to share a little bit about sharing information. One really important role that Head Start programs and other early learning programs play is that you guys are a really great trusted source of information for the families that you serve. 

By sharing the knowledge that you have about lead poisoning prevention with families, you can empower them to take steps at home as well. I wanted to share with you a story from a friend of mine. This is a story in her own words, and it really struck a chord with me, I wanted to share it. 

I have worked in public health, teaching moms about parenting and child growth and development for many years, starting before I had any children. Finally, when I had my own children, I was excited to do everything I could to help my child develop normally, both emotionally and physically. I took them to all their well-child appointments and read books on nutrition, parenting skills and how to promote their development. 

We raised our children in a home built in 1946 that we, over many years, did remodeling projects and painting on. To save money we did the work ourselves. Our boys love to play outside in the yard, and sometimes in the dirt around our home. But I never heard we loved raising our boys in our home, but I never heard anything about lead from my pediatrician or from my training.

I didn't know that lead-based paint was frequently used in homes built before 1978, and that the older the home, the higher the risk that lead-based paint was used. I didn't know that remodeling and disturbing the paint could have exposed my children to lead dust. I had no idea that the dirt around the home that they played in could have lead in it from the exterior paint used in the 1940s. 

I had no idea that lead dust could have been in our home. I didn't suspect anything environmental when two of my three children needed speech therapy, when one had challenging behavior issues, or when one had a learning disability. 

When I learned about lead, I was upset. Why didn't I know? Why hadn't I heard about this? Why didn't I get any information from my doctor or my children's care providers when they were young? I also can't know, for sure, if their speech, behavior, or learning disabilities were caused by a lack of knowledge about the possibility of lead in and around our home but it might have been. 

I just know I wasn't given the chance to prevent any possible exposure, because I didn't know. That information would have been a gift to me as a new mom, trying to do everything I could to give my child the best start in life. I wish I had been given that gift of information. 

You all can give families that you serve that gift of knowledge by sharing the steps that you take to protect children at your site from lead hazards and paint and water. Sharing the plan that you put together with them, you're not only letting families know that protecting children is important to you, but you’re giving them information they can use at home as well. 

On the Head Start website and your links to these are on your resource sheet, there are lots of great handouts that you can share with families. Also encourage your families to talk to their child's health care provider about blood lead testing. For those kids who are enrolled in Medicaid, blood lead tests are actually required at 12 months of age and 24 months of age. 

If they didn't get tested at those points, then at least once by age 5. Not all health care providers actually are even aware of this requirement. They may need to have their parents ask for that. 

Lastly, remind families that there really simple things that they can do, like frequently washing children's hands throughout the day and providing good nutrition with foods that are high in iron, calcium, and vitamin C. Those are not only good healthy practices, but they protect children against lead as well. Do share the information because you're also giving families a chance to have that important information to know. 

Melissa: Thank you, Michaela. I'm just getting thank yous for that important information. I'm going to pause for a moment and invite Steve Schuman to come off mute and moderate questions that you may have. 

Steve Shuman: Well, the questions were coming in fast and furious. We're not surprised. We know what an important issue this is for programs across the country. I'm going to try to capture some of the questions that were repeated by a number of folks. 

Including Michaela, should a program test the water that's used only for toothbrushing, or the water that's used outdoors to fill a water table that a child might drink just because they're young, and they put things in their mouth? 

Michaela: Yeah if there's a chance that the kids are going to drink the water, like in a water table, that would be a fixture that I would advise testing. Toothbrushing, I have heard both things. That it's little water that it's not necessary. But for an early learning program, I think it's always best practice to test those fixtures as well. 

Steve: Thanks. Another question that was asked a number of times, it was about and I think you touched upon it, Michaela. It was about the test kits that one can buy at a local hardware store. 

Michaela: Yeah for early learning programs, you really need to have it tested in a certified lab or by a certified lead risk assessor or inspector for paint. There are at-home test kits for paint. There are little sticks or swabs that you can use for paint. There are do it yourself kits for water. 

Those can give you an idea maybe if lead is present or not. But they don't test very low levels, and with little kids, especially those under the age of five, we're really concerned about those low levels. Those test kits just are not accurate enough for use in an early learning program. 

Steve: Thanks. Another question that was often asked was about paint. I think you made the point that we're really concerned with paint that's flaking or peeling or otherwise accessible to a young child through the air or falling on the floor. 

That could mean I'm just asking you, that could mean that the leaded paint is underneath some newly painted walls or doors or window frames, but it's all flaking off. Or it could be all encapsulated and nothing's flaking. Can you just comment on when we should be concerned about lead paint? 

Michaela: If the paint is in good condition, there's no flaking or chipping, it could be that there are many layers of newer paint that's not leaded over a base layer of lead paint, if it's all in good condition, really stuck to the wall, well, then it's not going to cause a lead hazard. It's not a risk. It's when it starts to chip or flake. That's even the case if there are lots of layers of newer paint on the top. If your paint is chipping off the wall, then it poses a hazard and you should get it fixed. 

Steve: I know we were talking today mostly about center-based programs, but we had a lot of home-based programs and family child care providers on today. I know we gave a resource for family child care homes to think about lead contaminants in their environments but we also have a lot of home visitors. You gave some suggestions for handouts to families. Is there anything else you might recommend a home visitor might share with a family to make sure the children in that home aren't exposed to lead in water or paint? 

Michaela: I think a lot of what we shared is relevant. First off, knowing how old the building is. Like a lot of homeowners actually do know how old their building is. If they're renters, the landlord should know. Finding out what is the risk? If it's an old building, a 1940 building, then there's likely lead there and making sure that the paint is in good condition, doing a water test. I mean, residents in homes can do those as well. I think all of it is pretty much relevant. 

Steve: Thank you Michaela. We had about 75 questions, we've answered, maybe 30 of them. We are going to go back and look and see what we can do to make sure that everybody's questions about lead in paint and water are answered. I can tell you that in the works is a lead in paint handout for the HeadStart.gov website that Michaela helped develop, and we hope to see that on the website at some point in the future. 

I would encourage everyone to really reread the standard the Performance Standard that Michaela cited early in her presentation. It really does answer a lot of questions if you read that standard closely. I also want to thank everyone in the chat who were giving great advice. Many programs have already contacted their Wynn-funded state agency and have helped them do the correct way to sample and test the water in their programs. 

I know there are a lot more questions that we didn't get to answer. I would encourage you to write to health@ecetta.info or post questions on MyPeers, and then I'm going to turn it over to Melissa to close us out. 

Melissa: Thank you. Steve and Michaela, it's been a pleasure to have you both. Thank you, Michaela for sharing your expertise and practical information for our audience. 

At this time, I want to just share we have another exciting event coming up. It's the 2025 Health and Mental Health Leaders Institute, or HMHLI that's on May 13th through 15th. It's free. It's all virtual, and it offers professional development for Head Start and other early childhood staff. We hope you'll be there. 

On this slide, you can pick up the QR code or the link from the chat. Please complete the evaluation about your experience today. Note that this evaluation survey is anonymous and your feedback helps us improve future training and technical assistance offerings. Thank you for choosing to spend a part of your day with us. We really enjoyed being together. 

If you have more questions after today's webinar, as Steve mentioned, please write to us at health@ecetta.info. You can find today's resources and more in the health section of the Head Start website. Subscribe 

Steve: Melissa can I just interrupt you one second? A lot of people are asking about certificates. The certificate is attached to the evaluation. When you complete and submit the evaluation, you will get access to the certificate. It is also linked on the handout that Michaela so nicely mentioned throughout the day. 

Melissa: Thank you, Steve, for that reminder. Yes, completing the evaluation unlocks the certificate. Thank you all. I'll leave it on this slide in case you still need to pick up the QR code. Thank you Michaela. Thank you, Steve, for everything. 

Michaela: Thank you. 

Steve: Thanks, everybody. It was a great session with many people joined us. 

Melissa: Yes. Many great questions. Kate, thank you. You can close the webinar.