The specialists at Boston Children’s Hospital were stumped. Usually when they encounter children with high levels of lead in their blood, the culprit is traced to chipped, lead-based paint in families’ homes or yards.
But disease trackers found no problematic paint at the home of a six-month old infant brought in last year with elevated lead levels and no other obvious source of contamination, including kitchenware, family hobbies, and his diet.
Additional probing revealed that since the boy was 2 weeks old, his family had been applying a Nigerian eye cosmetic and folk remedy that is 83 percent lead to the baby’s eye lids three to four times weekly. Called Tiro, his family believed it would make the boy more attractive and improve his vision. The child suffered no apparent harm, but now the case is prompting an alert from federal health officials about the risk of heavy metal poisoning from folk remedies found in many immigrant cultures.
A report Thursday from the federal Centers for Disease Control and Prevention details the puzzle solved by specialists at Children’s Hospital and highlights the number of cultures, including Asian, African, and Middle Eastern, that use similar products that may contain lead.
CDC officials advised obstetricians, pediatricians, midwives, and other health care professionals to discuss this potential health risk with patients during prenatal and early childhood medical visits.
Lead can harm the brain, kidneys, and nervous system, and children are particularly sensitive. Even low levels of lead can make it hard for them to learn, pay attention, and behave, according to health officials.
The CDC recently halved the lead blood levels considered safe for children, and state health officials have been sending out letters alerting physicians to the changes, and advising them that they may want to recheck children who tested at the levels previously considered safe but above the new threshold, said Suzanne Condon, director of the health department’s bureau of environmental health.
A Massachusetts law requires all children to be screened for lead poisoning annually up to age 3, and it was through this routine test that the infant’s pediatrician detected the problem. The family was referred to Children’s Hospital Pediatric Environmental Health Specialty Unit.
“The parents said it is quite common in some parts of their section of Nigeria for some families to use this as a beauty aide,” said Dr. Alan Woolf, a pediatrics professor at Harvard Medical School and director of the hospital’s specialty unit. “They said darker eyes add to the infant’s appearance but there is also a belief that this will improve their vision.”
Given the global crossroads that the Boston region has become, Woolf said his clinic is increasingly seeing families from different cultures who routinely use folk remedies and herbs that are unfamiliar to physicians trained in Western medicine, and contain high levels of lead and other heavy metals, such as arsenic, that are harmful.
One recent case involved a young family from Thailand who was in Boston finishing post graduate studies and had been using a traditional Thai treatment, a powder, on their infant son to remove white spots on his tongue sometimes caused by breastfeeding.
“Their belief ... was that applying this powder to his tongue daily would enhance his health by drawing toxins out of the body,” Woolf said.
“We want to be sensitive to the idea that these families have strong beliefs and some of those beliefs may be grounded in good health practices, but there should be a special awareness by health care providers” about potential risks, he said.
At Boston Medical Center, which cares for many immigrant patients, Dr. Rob Saper directs a program, called Integrative Medicine and Health Care Disparities, that combines Western medicine with evidence-based alternative therapies.
“Eighty percent of the world’s population uses [alternative] medicine of some form,” said Saper, an associate professor of medicine at Boston University School of Medicine. “What we consider to be alternative in the United States is often mainstream in other cultures such as in Asia and Africa.”
Saper said he has encountered patients who use kohl, another eye cosmetic with high lead levels, for religious or ceremonial purposes on children and adults.
Saper has researched some therapies often considered alternative in the United States, such as yoga for treating lower back pain, and found them to be low-cost and promising, while others, such as kohl, can be harmful.
“Our patient population is very much lower income, many of them immigrants who do not speak English as their first language,” Saper said. “We try to deliver this kind of integrative approach.”