Recent warnings about potentially high lead levels in recalled applesauce packets have put pediatricians on alert. While it is not yet clear if children exposed to these packets have experienced acute lead poisoning, experts advise taking the warnings seriously. According to Dr. Morri Markowitz, director of the Lead Poisoning Prevention and Treatment Program at the Children’s Hospital at Montefiore in the Bronx, blood lead levels of 20 micrograms per deciliter (mcg/dL) or higher in young children can lead to clinical disease in some cases. These levels are typically associated with a higher frequency of gastrointestinal complaints. Hospitalization usually occurs when blood lead levels reach 45 mcg/dL, and severe consequences, including death, can occur at levels of 100 mcg/dL.
The Centers for Disease Control and Prevention (CDC) reported 22 cases of elevated blood lead levels in children ages 1 to 3, all tied to cinnamon-containing applesauce packets. These cases have been identified in more than a dozen states across the United States. Blood lead levels in these cases have ranged from 4 to 29 mcg/dL. It is important to note that lead levels in children are considered elevated even at a level of just 3.5 mcg/dL. Dr. Markowitz expressed concern about these cases, but also cautioned that the amount of lead in the blood may not necessarily reflect the amount of lead present in the brain or accumulated in the bones. However, early lead absorption poses potentially lasting consequences, particularly in cognitive function and brain development.
Initial Flagging and Response
The cases were initially brought to the attention of the Food and Drug Administration (FDA) by officials in North Carolina. The North Carolina Department of Health and Human Services, while unable to provide specific information due to patient privacy, has stated that they work closely with local health departments and providers to identify children with elevated lead levels and assess potential exposures in their homes. According to state law, all blood lead test results for children under the age of 6 are reportable to the department. If a child under 6 has two consecutive blood lead test results of at least 5 mcg/dL, they are considered to have an elevated lead level and are eligible for a home investigation to identify the source of the lead hazard.
While lead-based paint and lead-contaminated water are well-known health hazards, it is crucial to recognize that lead can also be found in non-paint sources such as spices, ceremonial powders, and alternative medicines. A 2018 report authored by Kim Angelon-Gaetz, PhD, and colleagues from the North Carolina Department of Health and Human Services highlights the presence of lead in these non-paint hazards. This serves as a reminder for parents and caregivers to have their children tested for lead during their well-child visits at ages 1 and 2, as hand-to-mouth behavior is most common at these ages. Initial symptoms of lead poisoning may not be evident or easily identifiable, making regular testing even more important.
At the current stage, there are more questions than answers regarding the recent cases of elevated blood lead levels. It is still unclear where the lead contamination originated from. Investigations are ongoing to determine the ultimate source of lead in the recalled applesauce packets. The FDA relies on information provided by the North Carolina Department of Health and Human Services and other state agencies to issue public health advisories promptly.
The recent warnings about recalled applesauce packets and potential lead contamination have raised concerns among pediatricians and parents alike. While the immediate effects of lead in the blood may not always be apparent, the long-term consequences can have a significant impact on a child’s development and well-being. Regular lead testing is crucial to monitor children’s exposure and take appropriate actions to minimize the risks associated with lead poisoning.