The headlines in recent weeks have rattled the nerves of anxious parents with tales of lead-tainted Elmo toys and Thomas the Tank Engine accessories and Spiderman trinkets.
But the more serious lead hazard isn't what is being brought inside the house but what has been there all along: lead paint.
"The day-in, day-out constant risk comes from housing," said Ruth Ann Norton, executive director of Baltimore's Coalition to End Childhood Lead Poisoning.
Mostly the problem is in household paint, which contained lead until 1978, when the additive was banned nationwide. Baltimore and the state passed statutes in the 1950s prohibiting its use in new homes. But many older houses are still standing - more than 1 million across Maryland - and many have been poorly maintained, allowing lead dust and chipping paint to get on surfaces where it can be ingested by children.
Great strides have been made. Properties are being repaired, with lead removed and windows replaced. More children are being tested for high blood lead levels, which can be treated. Statewide, the number of youngsters with lead poisoning dropped from 14,546 in 1993 to 1,274 last year.
Still, new cases arise regularly. There were 573 reported in Baltimore last year - out of 936 statewide, according to state statistics. "That's not inconsequential," said Madeleine Shea, Baltimore's assistant health commissioner for Healthy Homes. Experts agree that most of the lead poisoning cases can be attributed to lead paint in homes, though lead in toys, cheap jewelry and candy might play roles in some cases.
Norton said progress has stalled in recent years, partly because of the city's successes in tackling the problem.
"People started checking it off in their heads as sort of done," she said. "It's not done."
Dr. Ellen Silbergeld, an environmental health professor at the Johns Hopkins Bloomberg School of Public Health, said every time it seems as though the issue of lead has been mastered, another surprise comes: toys, drinking water, old industrial sites. Some sources can be addressed more easily than others. She said there would be no talk of lead chipping off Big Bird toys if the use of lead paint was prohibited everywhere. She wonders what is happening to the children of China if the paint is so common there.
"It should remind everyone that unless you do something really thorough and dramatic such as banning a hazardous substance, you're never safe," she said.
Lead poisoning can result in poor school performance, inability to read, aggressive behavior, hearing loss or mental retardation. It is a more serious problem in low-income communities because those homes are often poorly maintained and people who live in lead-tainted homes often do not have the resources to escape their situations.
Housing still dwarfs all other sources of lead poisoning, said Dr. Joshua M. Sharfstein, Baltimore's health commissioner: "There's a misconception that it's not as much of a problem anymore."
Typically, officials haven't learned about lead problems inside a home until a child living there shows an elevated blood lead level. Sharfstein said the city is trying to be pro-active, making lead education part of pre-natal home visits.
When the Thomas the Tank Engine recall was announced in June and the Fisher-Price Sesame Street recall last week, it underscored that lead can always be a danger and those who might not have worried about it - middle-class suburbanites - could still be affected.
"This touches so many people who now have a lead risk who didn't," Norton said.
Few cases of lead poisoning have been directly linked to lead toys or trinkets. Last year, a 4-year-old Minneapolis boy died after ingesting a charm given away by Reebok.
Dr. Peter L. Beilenson, Howard County's health officer and Baltimore's former health commissioner, said Howard County reported only a few cases of elevated blood lead levels in the past year out of 270,000 residents. If leaded toys were a major problem, the numbers would be much higher, he said.
Still, he said, any exposure to lead is cause for concern. He knows that parents of young children who tend to put everything in their mouths are worried about hidden hazards suddenly posed by Fisher-Price toys. He went home and checked his child's Diego figurine, he said.
"Obviously we don't want kids unnecessarily exposed to lead," he said. But he doesn't want to lose perspective, either: "We don't want to take our eye off the ball that we still have a significant problem with older housing stock."