Lead in Children's Toys: Questions and Answers for Health Care Providers

Recently, there have been multiple recalls of children's toys because they contain lead-based paint. As parents become aware of these recalls, you may be contacted by concerned parents. We have identified commonly asked questions about lead in children's toys and childhood lead poisoning for your use.

Parents have been calling my office to ask if their children should have lead tests because of the recent toy recalls. What guidance should I follow?

Under New York State Public Health Law, health care providers are required to screen all children with a routine blood lead test at age one and again at age two, and to conduct a risk assessment for lead exposure for all children up to age six at least annually, with blood lead testing for children identified as having a lead exposure risk.

The State Department of Health recommends that parents concerned about lead exposure from recalled merchandise, discuss the need for blood lead testing with their health care providers. Blood lead tests should be done for all children less than age 6 years old who have played with one of these toys, especially if the child frequently chews on toys or puts toys in his or her mouth, or has frequent hand-to-mouth activity that is typical of young children. Although there are not enough studies to know for certain, the Department of Health believes that the greatest risk of exposure to lead from toys comes from frequent chewing or mouthing on the toy, or from frequent hand-to-mouth activity. Just holding or playing with the toy with hand contact alone may not result in as much lead exposure. Parents should talk with their health care provider about the need for blood lead testing and any other questions they have about lead poisoning. Local health departments can also serve as a valuable resource on childhood lead poisoning prevention.

Which toys have been recalled?

On August 2, 2007, Fisher-Price recalled approximately 967,000 toys, including Sesame Street, Dora the Explorer, and other licensed characters. In addition, on August 14, 2007, Mattel recalled approximately 253,000 toy "Sarge" cars. On June 13, 2007, RC2 Corporation recalled approximately 1.5 million "Thomas and Friends" wooden railway toys. There also have been a number of smaller recalls for a variety of children's products this year. For a complete list of lead-related toy recalls, visit the state Department of Health's Lead Hazard Product Recall Web site at http://www.nyhealth.gov/environmental/lead/recalls/ or the Consumer Product Safety Commission's Web site at http://www.cpsc.gov.

What should be done with toys that have been recalled?

Children should not be allowed to play with recalled toys. Parents should be instructed to put the toys in a place where children cannot find them, until the toys can be returned or destroyed as directed. Because each recall is different, the State Department of Health recommends that you check the recall notice to learn how to return the toy for a refund or replacement. Recall notices are available through the Department's Web site at http://www.nyhealth.gov/environmental/lead/recalls/ or the Consumer Product Safety Commission's Web site at http://www.cpsc.gov.

What do I tell parents about other toys not currently on the recall list?

It is difficult to answer questions about toys that a child currently owns unless the toy has been recalled. Parents can check the Consumer Product Safety Commission (CPSC) Web site http://www.cpsc.gov for information on prior recalled toys and children's jewelry.

Parents may ask about the use of commercially-available home test kits to detect lead in toys, paint, dust, or soil. Studies show that these kits are not reliable enough to tell the difference between high and low levels of lead. At this time, the State Department of Health and the Federal Environmental Protection Agency do not recommend use of the kits for lead testing whether done by homeowners or certified lead-based paint professionals.

What is my responsibility as a health care provider for lead testing children in NYS?

Under NYS Public Health Law and Regulations, health care providers are required to screen with a blood lead test all children at or around age one year and again at or around age two years. Health care providers are also required to do a lead risk assessment at least annually for all children up to age six years and test all children found to be at risk for lead exposure.

If you send children to an outside laboratory for blood lead testing, it is important to follow up with the parents/caregivers if you do not receive blood lead level results from the laboratory.

The purpose of routine lead screening is to identify children who have elevated blood lead levels, and to implement appropriate follow-up. While children can be exposed to lead from a number of possible sources, lead dust and paint chips from deteriorating lead paint are still the leading source of childhood lead poisoning in NYS. New York State has the largest number and proportion of old housing in the entire nation. Children who live in old housing (all housing built before 1978, but especially housing built before 1950) may be at risk for exposure to lead if the paint is chipping, peeling, or otherwise wearing down due to disrepair, or renovation and remodeling if lead-safe work practices are not followed. Of the approximately 5,000 children diagnosed with lead poisoning each year in New York State, the vast majority are exposed to lead from lead paint in housing.

How should I assess children for a possible lead exposure?

Health care providers are required to do a risk assessment for possible lead exposure for all children up to age six years at least annually and thereafter, if a risk of exposure is suspected.

The following questions should be included in a lead risk assessment:

  • Does your child live in or regularly visit a house or building built before 1978 with peeling or chipping paint, or with recent, ongoing or planned renovation or remodeling? This could include a day care center, preschool, or the home of a babysitter or a relative.
  • Has your family/child ever lived outside the United States or recently arrived from a foreign country?
  • Does your child have a brother, sister, housemate or playmate being followed or treated for lead poisoning?
  • Does your child frequently put things in his or her mouth such as toys, jewelry, or keys? Does your child eat non-food items (pica)? Note: This may include toys or jewelry products that have been specifically recalled by the Consumer Products Safety Commission (CPSC) due to identification of unsafe levels of lead.
  • Does your child frequently come in contact with an adult whose job or hobby involves exposure to lead? Note: Jobs with risk of lead exposure include house painting, renovations, construction, welding or pottery making. Hobby examples are stained glass or pottery, fishing, firearms and collecting lead figurines.
  • Does your child live near an active lead smelter, battery recycling plant, or another industry likely to release lead or does your child live near a heavily traveled major highway where soil and dust may be contaminated with lead? Note: May need to alert parent/caregiver of such a local industry.

Ask any additional questions that may be specific to situations in a particular community.

If the answer to any of the above questions is YES, then the child is considered to be at risk of high dose lead exposure and should be screened with a blood lead test.

As a reminder, under NYS Public Health Law and Regulations, health care providers are required to screen all children at or around age one year and again at or around age two years with blood lead tests.

What are the symptoms of childhood lead poisoning?

At lower blood lead levels, a child with lead poisoning usually does not look or feel sick. The only way to know is to get a blood lead test. In the past, lead exposure was often not diagnosed until a child had a very high blood lead level (≥ 70 mcg/dL) with symptoms of lead toxicity such as lethargy, ataxia, seizures, and coma. Children with these symptoms require immediate hospitalization and treatment. However, blood lead levels in this range are now extremely uncommon. The vast majority of children with lead poisoning will not have any obvious signs or symptoms.

What if a child doesn't have health insurance that will cover a blood lead test?

If a child does not have health insurance, or insurance does not cover blood lead tests, contact the local health department. They can help the child get a blood lead test. They will also help parents to get health insurance for their child.

How can I receive updates on future lead-related recalls?

Lead-related recalls are posted under "Public Health Notices" on the main page of the Health Information Network (HIN). Additionally, you can sign up to receive e-mail notifications of recalls from the Consumer Product Safety Commission's Web site at http://www.cpsc.gov/cpsclist.aspx.