Rebecca Cromwell, a chemist at the Maine Center for Disease Control and Prevention's Health and Environmental Testing Laboratory in Augusta, stands beside equipment used to test blood samples for lead poisoning. Credit: Courtesy of the Maine Center for Disease Control and Prevention

Lead testing of Maine’s youngest and most vulnerable children is on the rise, with only a temporary dip early in the pandemic, moving the state closer to its goal of eradicating lead poisoning by 2030.

A 2019 law that broadened screening and a trend toward more in-office rather than at-the-lab testing boosted screens for the heavy metal, which can damage the brains of young children. The law widened testing to all children aged 1 and 2 instead of only those covered by MaineCare, the state’s version of Medicaid. Monthly tests were up 43 percent this March compared to June 2019, when the law went into effect.

While testing dipped in March and April of last year, when Gov. Janet Mills’ COVID-19 civil emergency proclamation discouraged non-urgent medical care, it quickly got back on track once office visits were again allowed.

Maine Senate Majority Leader Nate Libby, D-Lewiston, with his 7-month-old son Charlie at a press conference in Lewiston on Oct. 29, 2019. He and other politicians and health officials were calling attention to a new law that mandates testing of a 1- and 2-year-olds for lead exposure. Credit: Lori Valigra / BDN

“And we think it will continue to increase,” Karyn Butts, manager of the Childhood Lead Poisoning Prevention Unit at the Maine Center for Disease Control, said.

The federal government banned lead paint in 1978, but one-third of Maine’s housing was built before 1950 and likely still contains it, according to a 2019 report by Health Justice Innovations. Lewiston has the most children with high lead tests, but Portland, Auburn, Biddeford and Bangor also ranked among the state’s top five locations for high lead tests.

Babies are especially at risk because they crawl on the floor, where lead paint chips and dust fall, and put their hands in their mouth, Andrew Smith, the state toxicologist, said. Exposure to even low levels of lead has been shown to damage the brain and nervous system, slow growth and development, cause learning and behavioral problems and cause hearing and speech problems, according to the U.S. CDC.

Tests for lead poisoning, which in Maine usually results from exposure to lead paint in old housing, rose from 1,255 in June 2019 to 1,963 in January 2020, but fell to 719 in April 2020, the first full month of pandemic restrictions in Maine, according to Maine CDC data.

Tests began recovering last May and by June 2020 they rose to 1,738 and kept a strong monthly pace to hit 1,796 this March. Inspections followed a similar trend, declining 55 percent to 34 home visits from last March to May compared to the previous three months, but rebounding as the number of tests rose.

The state has been getting more aggressive over the past several years about catching lead poisoning earlier, Smith said. Children are first given a stick-finger blood test, and if it shows elevated lead levels, they get a more thorough test with blood drawn from a vein. If that test confirms the high lead level, the Maine CDC sends an inspector to check the child’s home, both inside and out, and the soil for lead. Inspectors will try to educate homeowners, landlords and tenants and recommend remediation if necessary.

A sign warns of lead abatement work going on at 54/56 Shawmut St. in Lewiston in this Aug. 27, 2019 file photo. Credit: Troy R. Bennett / BDN

The national CDC has set the high level for lead in blood at 5 micrograms per deciliter. Maine adopted that level in 2016, dropping from the previous 15 micrograms per deciliter. The new level went into effect in 2017. Smith said many states still do not conduct inspections until a child has a lead blood level of 10 micrograms per deciliter or higher.

“Part of the reason for screening and getting in there is to identify hazards,” Smith said. “So the fact that we’re now acting at 5 micrograms per deciliter means we can intervene when the blood levels are still relatively low, and we’re moving aggressively on those.”

Besides the law, in-office testing has increased in the past year, a move Smith called a “game changer” in getting parents to have their children tested in their pediatrician’s office during a wellness checkup. Until last year, most tests were done in a separate lab, and not all parents followed through to take their children for testing. Smith said only about one-third of testing was done by doctors a few years ago, but that is up to half now.

Some of that increase can be traced to a system-wide focus at MaineHealth starting last September to have its pediatricians take the finger stick and get immediate test results on an instrument in their office. That saves on the time to get a patient to an independent lab, where they may not get immediate results.

Of the nearly 4,800 tests reported to the Maine CDC from September 2020 through this March, 34 percent were done in office by MaineHealth practices. By this January, finger-stick tests analyzed in doctors’ offices outnumbered those analyzed at the Maine CDC’s lab, which continued to process lead tests at the same time it was handling COVID-19 and other tests, Butts said.

Cassandra Cote Grantham, director of child health programs at MaineHealth, said that after the law came into effect, the health system wanted to make it easier for parents to get their children tested and for health providers to comply with the law.

“It is a challenge at a wellness visit when your child just had shots and has been poked and prodded and cooped up in a little room for half an hour, and then your provider asks you to go to a lab and have a blood draw,” Grantham said.

Independent practices, including Pediatric Associates of Lewiston, have been testing children aged 1 and 2 in-office for years. Even so, it’s still a challenge to get parents to agree to the test, Dan Hett, the office’s administrator, said. Parents in newer homes may not think their children are exposed to lead, but it may happen during visits to daycare centers or to relatives or friends in older homes.

Dr. William Stephenson, a pediatrician at Pen Bay Medical Center in Rockland, a MaineHealth affiliate that takes blood samples in the office, said the recent law has helped get more parents to comply with testing.

“It made it a lot easier for us to say, ‘I understand you feel like you don’t have any risk factors, but we’re going to test you,’” he said.

Stephenson said it effectively takes a village after what he called a “brain poison.” A 2016 health assessment by several hospitals found that midcoast counties had low testing rates. Knox County, where Stephenson’s practice is located, set testing as a priority, and screening rates there almost doubled for children aged 1 and 2 between 2017 and 2019.

“It takes a team, so the law at the state level, the commitment at the county level, the staff at the office and the parents,” Stephenson said.

For information about lead poisoning prevention or testing children for lead, call the Maine CDC’s Childhood Lead Poisoning Prevention Unit at 866-292-3474 (toll-free in Maine), 207-287-4311 or TTY: Call Maine Relay 711 or visit its website.