Ronnell Doughty looks healthy enough as he eats his hospital breakfast and watches cartoons on television.
Then a nurse at the Kennedy Institute for Handicapped Children picks up the 14-month-old boy and carries him down the hall for a ritual that is painfully familiar.
Ronnell starts to squirm and fuss as he is placed on a stretcher. Another nurse approaches with a syringe, and he begins to cry even before he feels the hypodermic needle in his thigh.
In half a minute, it is over. The toddler's tears stop as Elva White, his grandmother, comforts him.
Ronnell has lead poisoning. For four weeks last month he had to be hospitalized so he could receive almost daily injections of medicine designed to draw the hazardous metal out of his body.
He seems fine now, but his future may be dimmer because of where his family unwittingly chose to live 2 1/2 years ago -- in an old rented rowhouse in Waverly where Ronnell probably ingested the dust from lead-based paint.
Many less-severe cases of poisoning go undetected, and recent research suggests that lead's toxic legacy can last a lifetime for such youngsters, contributing to failure in school and on the job -- and perhaps even pushing children toward violent, anti-social behavior.
The number of poisoning cases severe enough to require hospitalization is deceptively small -- just a few dozen Maryland children per year. But state health officials estimate that as many as 166,000 youngsters under age 6 in the Baltimore-Washington area may be exposed to low, but still harmful, levels of lead.
Such levels of lead in the bloodstream seldom produce obvious symptoms and are well below what is now officially considered poisoning. But recent medical studies indicate that these levels can cause permanent neurological and physical damage, such as learning and behavioral problems and stunted growth.
"ENORMOUS PROBLEM"
"It's an enormous problem, and we are really not coming to grips with it," says Ellen K. Silbergeld, a University of Maryland toxicologist who heads Gov. William Donald Schaefer's advisory council on lead poisoning. "If this were an infectious disease, there would be a national uproar."
A 1984 federal study reported more than 11,700 poisoning cases in 26 cities across the country. In Maryland, there were 544 poisoning cases in 1989, with all but 41 of them in Baltimore, according to the state Department of the Environment.
But that's just the tip of an invisible epidemic that reaches beyond the city into the suburbs and rural areas, say state officials. Poisoned children generally show no symptoms, and most cases go undetected because only a fraction of the children at risk are ever checked.
"We have a serious public health problem that nobody is even looking for," charges Don Ryan, executive director of the Alliance to End Childhood Lead Poisoning, a Washington-based group of doctors, environmentalists and other experts.
The federal government, long accused by public health advocates of neglecting the problem, is showing signs of waking up. Federal health officials say lead poisoning is the most common environmental disease afflicting America's young children today, threatening far more youngsters than was previously thought.
The Bush administration has mapped out a five-year, $1 billion plan for eradicating lead poisoning, and has asked for $41 million in federal funding to screen children and to remove lead-paint hazards from homes.
But public health advocates say the increase in funding sought by the president is nowhere near enough to tackle the problem. And they contend that local, state and federal agencies already are failing to cope with the more limited number of serious poisoning cases.
A lack of both money and political will has allowed the lead problem to persist, say public health advocates. And Baltimore is no exception, even though the city once was a pioneer in efforts to curb lead poisoning.
"Maryland has been ahead of the game, but things are changing," says Patricia McLaine, lead poisoning prevention director for the state Department of the Environment. "We won't be able to do the job."
BANNED SINCE 1977
Throughout the nation, lead was widely used until about a decade ago in paint, plumbing, gasoline and food cans. It has been banned from household paint since 1977, and its use in fuel, food packaging and plumbing also has been sharply curbed.
This helps explain a decline in severe poisoning cases and the virtual elimination of lead-related deaths in the past 20 years, though a 28-month-old Wisconsin boy did die last year.
But lead poisoning today is largely a legacy of the metal's past popularity. About 3 million tons of lead can be found in paint inside or on the exterior of 57 million U.S. homes, nearly three-fourths of all houses built before 1980, according to a recent survey by the federal Department of Housing and Urban Development. Maryland has 500,000 homes -- 200,000 of them in Baltimore -- that were built before 1950, when lead paint was widely used.
Another 4 million to 5 million tons of lead linger in dust and soil, toxic fallout from the days when cars and trucks burned leaded gasoline.
"There is no reason to think that just because you live in a very nice area that you're immune to this," says Bruce Fowler, another University of Maryland toxicologist and chairman of the governor's advisory commission on toxics.
Until recently, lead poisoning in children was generally viewed as a tragic but limited problem -- an affliction only of disadvantaged, poorly supervised youngsters who ate chips of lead-based paint flaking from the walls of dilapidated tenements.
But researchers now believe that most poisoning stems from the entirely normal behavior of otherwise healthy infants and toddlers, who stick thumbs and fingers and other objects in their mouths after picking up lead dust from floors, windowsills and elsewhere.
MANY KIDS AT RISK
Most of the serious lead-poisoning cases officially counted to date have involved inner-city children. But research in the past five or six years indicates that a much larger segment of the population is at risk from lead's harmful effects.
Moreover, recent studies have found that lead levels well below the official threshold for poisoning can impair a child's neurological and physical development.
The federal government has responded by periodically lowering the threshold; the standard has dropped from 60 micrograms of lead per decileter of blood in 1960 to 25 micrograms per decileter in 1985, where the threshold remains today.
The most recent studies, however, have found that lead can damage children at levels as low as 10 micrograms per decileter -- less than half what is now officially considered poisoning.
Prompted by such research, the federal Centers for Disease Control plans this year to lower the standard to 10 micrograms per decileter, says Susan Binder, CDC director of lead-poisoning prevention. That action, expected by mid-year, could expand the number of children at risk by more than 10-fold.
While only 1.5 percent of all children living in urban areas in 1984 were believed to have lead levels high enough to be considered poisoned, officials estimate that as many as 4 million children -- one in six youngsters between the ages of six months and five years -- have lead levels above 15 micrograms per decileter.
In urban areas with much older housing, like Baltimore, the percentage of children at risk from low-level lead exposure is even higher, as many as six in 10 youngsters between six months and five years.
DEFICIENCIES MEASURED
A study done in Boston and published earlier this year found that children born with as little as 10 micrograms of lead per decileter of blood in their veins performed worse on learning and hand-eye coordination tests at age 2 than did children with lower lead levels.
About 400,000 children born each year may be exposed to lead levels that high or higher through blood supplied to the womb by their mothers, according to a 1988 report by the federal Agency for Toxic Substances and Disease Registry.
Infants with low-level lead poisoning may be able to make up their learning deficits by age 5, the Boston study suggests, but only if further exposure to lead is curtailed. Children whose lead levels did not go down, and those whose parents were poorer and less educated, did not recover their lost learning ability.
"Lead exposure, while it is not a problem of poor children alone, is visited on poor children at a much higher rate," says Dr. Herbert L. Needleman, a pediatrician and one of the researchers involved in the Boston study.
Needleman's and other's studies have found that children with lead levels as low as 10 to 15 micrograms scored four to six points lower on intelligence tests than did children even less exposed to lead. Moreover, fewer children with elevated lead levels registered superior intelligence, while many more scored below normal on IQ tests.
Another study by Needleman published last year indicates that the harm done by lead poisoning can last into adulthood. Children with high lead levels in the mid-1970s were six times more likely to drop out of school and seven times more likely to have learning disabilities, the study found.
Needleman says he also believes that lead poisoning may contribute to juvenile delinquency and crime. Learning disabilities and aggressive tendencies, two traits linked with lead poisoning, also contribute to antisocial behavior, he notes.
"I'm not saying that lead is the cause of delinquency," Needleman cautions. But he contends that it could be "an important contributor."
DIFFERING VIEWS
Needleman's views on lead's links with crime are not universally shared, and some researchers have found no consistent or significant health effects from low-level lead fTC exposure. But federal health officials say that the bulk of the studies so far have found that children's learning ability is harmed by lead levels below the current federal poisoning threshold.
The impact of low-level lead exposure on individual children is difficult to predict, health officials say, because lead does not affect every one the same. And other factors, such as parental stimulation, have a great influence on early childhood development.
But public health officials and many researchers say they are troubled by the broad social impact of widespread low-level lead exposure. By reducing average intelligence, however slightly, experts warn there could be far fewer super-bright children and many more of marginal or low intelligence, increasing costs to taxpayers for special education and welfare.
"We're basically 'dumbing down' our kids," says the University of Maryland's Silbergeld.
"It may mean we have fewer Einsteins as a result," adds Robert Percival, a University of Maryland environmental law professor. And it could undermine America's ability to compete economically with other countries where lead exposures are lower, he says.
Health advocates say they hope that a broader definition of lead poisoning will dispel the myth that this is only a problem of the poor.
"Previously, it had been dismissed as the 1 or 2 percent of kids who were never going to make it anyway," says Ryan, of the lead poisoning alliance. "Now we have just a ton of kids."
But others say they fear that lowering the poisoning threshold could swamp local and state agencies already struggling to cope with existing caseloads.
"That is just going to overwhelm the city with lead-poisoned kids," warns James Keck, former lead poisoning prevention coordinator for the Baltimore Health Department, who is now a lead-abatement consultant.
"It's going to take a national commitment," contends Dr. Julian Chisolm, director of the Kennedy Institute's lead-poisoning clinic and a leading researcher in the field.
NO-LEAD GAS HELPS
There have been significant gains in curbing lead exposure in the United States in the past 20 years. The average level of lead in the bloodstream of Americans has dropped 50 percent since the mid-1970s.
That improvement is mainly because of the reduction in use of leaded gasoline since 1976.
But the average amount of lead in Americans' blood today remains about eight micrograms per decileter, just below the level at which researchers have found harmful effects on infants and young children. And the University of Maryland's Fowler says some researchers are beginning to doubt that there is any safe level of lead for humans.
"We really haven't found the bottom yet," he says.
The biggest known source of continuing exposure to lead is household paint. While cities such as Baltimore have the greatest concentrations of older homes with lead-based paint, the problem is not limited to the city. Baltimore County, for example, has about 66,000 pre-1950 homes.
"We have thought of lead as being an inner-city problem," says Fowler. "That isn't so. Any house with lead paint that isn't well maintained is a problem."
The children most at risk of lead poisoning are those living in substandard housing or homes undergoing renovation, which creates hazardous lead dust as old painted surfaces are stripped or sanded. But for the larger spectrum of children vulnerable to low-level poisoning, other sources of lead may be major factors, such as dust or soil outside or drinking water that passes through plumbing with lead pipes or solder.
There are two basic facts to remember about lead, Fowler says. First, "it's forever." As an element, lead can never be destroyed or broken down into something less toxic. Once released into the environment, it remains.
And, second, "there isn't a single living thing on the planet Earth that isn't exposed to it," Fowler says. Lead, or at least traces of it, can be found practically everywhere -- in the atmosphere, in streams and in soil.
"Lead is a drug you can't 'say no' to," he points out.
For Ronnell Doughty, whose lead level was 50 percent above the poisoning threshold, only time will tell if it will keep him from growing up normally. Elva White, his grandmother, says the doctors at Kennedy told her that "right now . . . as far as they could tell, there are no delays" in his development.
"But that's something we're going to have to watch," she says.
For more information
Call the Maryland Dept. of the Environment at 631-3859 for information on: medical testing, testing of homes for lead-based paint and what to do if you find it. Your local health department also can help.
NEXT: One family's ordeal.