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What to Know about Lead Exposure in Children

A recent outbreak of lead poisoning from cinnamon in applesauce has drawn attention to the toxic effect the heavy metal can have on children. The cinnamon in the applesauce was believed to have been intentionally contaminated, possibly to add to its value as a commodity sold by weight. It had unusually high levels of lead.

The Centers for Disease Control and Prevention estimates that more than 400 children were poisoned in the applesauce outbreak. Their median blood lead levels were six times higher than the average seen during the height of the Flint water crisis, the C.D.C. said.

While such poisoning cases are rare, lead is a widespread contaminant and has been under increasing scrutiny. Here’s what you need to know.

Paint is one of the most common and well-known sources of lead. Children can also be exposed by drinking water that flows through old lead pipes.

Lead poisoning through food is less common but does occur. Lead can get into food at low levels when plants draw it up from the soil. For instance, a study about baby foods found that sweet potatoes had some of the highest levels of lead among the products tested.

A lead-based pigment is sometimes illegally added to spices to bulk them up or make their color pop. The Food and Drug Administration suspects that the additive caused the applesauce contamination last year.

The F.D.A., relying on investigators in Ecuador, said that a spice grinder there likely added the pigment, lead chromate powder, to cinnamon before it was blended with the applesauce.

An investigation by The New York Times and the nonprofit health-journalism organization The Examination found that the cinnamon and the tainted applesauce then slipped through every checkpoint meant to safeguard the U.S. food supply. The Ecuadorean food processor Austrofood was not required to test for toxic metals and did not, records show.

International inspections by the F.D.A. have not come close to meeting a goal in a landmark 2011 food-safety law. The agency is conducting half as many spot checks of food at the border as they were a decade ago. Food importers, which are required to vet foreign food, let the applesauce enter the country.

Lead exposure can go unnoticed until levels accumulate, doctors say. High levels of lead can result in stomach pain, vomiting, fatigue, learning difficulties, developmental delays and even seizures.

Pediatricians recommend blood tests for infants and toddlers who live in homes built before 1978 or have other risk factors. Medicaid programs and some states require screening, but it is not typically advised for children older than 3.

While officials have said there is no safe level of lead, parents do not automatically need to worry if traces of lead show up in a child’s blood test. The average blood-lead level among young U.S. children is under 1 microgram per deciliter of blood. “I don’t think they should be worried at all,” said Kim Dietrich, a professor emeritus of epidemiology and environmental health at the University of Cincinnati College of Medicine.

Studies finding I.Q. score deficits and links to A.D.H.D. tend to focus on children with levels at 5 and above. According to the C.D.C., about 95 percent of children in the United States have lead levels under 3.5 micrograms per deciliter of blood.

Some experts have even begun to question the C.D.C.’s position that there is “no safe level” of lead, given its ubiquitous nature and the minor effects that low levels have had on millions of children in the United States.

Parents can be sure their children are getting a healthy diet rich in calcium and iron, minerals that are absorbed through the same pathways as lead, said Dr. Ana Navas-Acien, chairwoman of research at the Columbia University Department of Environmental Health Sciences.

She said another good strategy is to feed young children a wide variety of foods, an approach that can limit the harm of consuming too much of one tainted product. If children have exposures that impact their development, Dr. Navas-Acien said, parents can counteract some of the effects by keeping children in a stimulating educational environment and talking, reading and playing with them.

The Biden administration has invested billions of dollars to upgrade old lead water lines and housing.

The F.D.A. says it is reviewing the applesauce poisoning to determine if the agency needs to make changes. So far, officials have said little about the failure of thousands of food import companies to launch programs to vet foreign food.

The F.D.A. also says it wants to move ahead with its “Closer to Zero” initiative, asking Congress to give it the authority to set lead limits in foods marketed to babies and toddlers and to require companies to perform tests. A group of 20 attorneys general have called on the F.D.A. to use its existing powers to make the move.

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