The Hogan administration plans to require that all Maryland 1- and 2-year-olds be tested for lead poisoning, declaring the new rule is needed because thousands of youngsters are still at risk for health problems.
Under the plan announced Monday, an estimated 175,000 children statewide will be tested in their first two years, expanding on an approach that has focused on screening poor youngsters and those living in communities with older housing.
"Lead poisoning has no boundaries," Lt. Gov. Boyd Rutherford said in announcing the initiative at a West Baltimore health clinic. While testing mainly in high-risk areas like Baltimore City made sense in the past, Rutherford said that if lead poisoning is to be eliminated, "we must reach all areas of the state."
Lead is a potent neurotoxin that can cause lasting harm to the developing nervous systems of young children if they ingest even tiny amounts. The leading source of exposure is lead-based paint, which once was widely used in homes. But other sources include tap water from old plumbing with lead solder, and lead-glazed porcelain and ceramic dishes.
State health officials say they expect to finish regulations early next year so that every child will have his or her blood tested twice — at ages 1 and 2 — for elevated levels of lead. Health care providers will be encouraged to use rapid testing technology so parents can be informed immediately, said Dr. Clifford Mitchell, the state's director of environmental health. Quick test results will mean that action can be taken promptly to investigate and eliminate sources of exposure, he said.
In opting for universal testing of toddlers, Maryland follows states such as Rhode Island and Massachusetts. The U.S. Centers for Disease Control and Prevention has never found universal testing to be warranted.
"Since 1997, CDC has recommended that the states use local data to develop childhood blood lead screening plans that are responsive to local conditions," said Mary Jean Brown, chief of CDC's Healthy Homes and Lead Poisoning Prevention Program.
Testing in Maryland to date has followed CDC guidelines, focusing on poor children on Medicaid and on youngsters living in areas with a lot of housing built before 1950, when lead paint was almost universally used.
Last year, under that policy, 109,000 children up to the age of 6 were tested, just under 21 percent of all youngsters in that age group. Test rates were significantly higher for 1- and 2-year-olds in Baltimore City, but in some suburban counties fewer than 10 percent were tested.
Once a widespread health problem, the number of children poisoned by lead in Maryland has declined by 97 percent since the 1990s, when the state tightened oversight of lead-paint risks in older rental housing. This year the state expanded its oversight to cover all rental homes built before 1978, the year lead interior house paint was banned nationwide.
The number of Maryland children found to be poisoned last year was 355, according to the latest state figures. Another 2,004 youngsters had lower but still elevated levels of lead in their blood, which poses similar health risks to chronic exposure.
While many children who live or have lived in high-risk areas already must present proof they've been tested for lead before entering school, health officials and advocates believe testing everyone earlier in life would spare some youngsters from harm.
"If we catch them early, we'll catch them before they go on to get a chronic lead exposure," Mitchell said. State officials plan to review the results of the expanded testing after three years and may adjust the requirements after that, he said.
Advocates praised the Hogan administration's move, noting that the current targeted screening has had uneven results.
"The sooner we intervene to prevent our children from being poisoned the better," said Del. Samuel I. "Sandy" Rosenberg, a Baltimore Democrat who has promoted legislation to address the problem.
"We support testing as early as you can do it," said Ruth Ann Norton, a longtime advocate. But Norton stressed that more testing will only spot previously unsuspected exposures, not prevent the harm.
"It's not the end-all," she said, adding that more resources need to be directed into upgrading housing to eliminate lead paint and other hazards.
State health officials estimate that expanded testing and follow-up with poisoned children could cost $4 million to $6 million annually. But state health department spokesman Christopher Garrett said the estimate includes money already being spent on lead testing for children enrolled in Medicaid and living in affected areas.
"Also note," Garrett added, "that the cost savings from preventing even one child from going on to have chronic lead poisoning are substantial." Children with lead poisoning can experience lifelong learning and behavioral problems.
It's not clear if parents will have to pay for the tests. Medicaid already covers testing for poor youngsters. Private insurance coverage for lead testing varies, according to Joseph Sviatko, spokesman for the Maryland Insurance Administration.
But the health department's Mitchell said, "We anticipate insurers will cover it."
Health care providers wanting to give their patients instant test results may have to spend about $2,000 for equipment to analyze the blood in the office, according to Garrett.
Dr. Susan Chaitovitz, a Frederick pediatrician and president of the Maryland chapter of the American Academy of Pediatrics, said she expects health care providers would go along with the requirement. She said she's seen lead-poisoned youngsters in her practice, including one who got it from eating contaminated imported candy.
"It is a change, but in some ways it's an easier change," Chaitovitz said of the testing requirement. "Trying to identify which kids need testing when is always a harder strategy in some ways than just going ahead and doing it on everybody."