The specialists at Boston Children’s Hospital were stumped. Usually when they encounter children with high levels of lead in their blood, the problem is traced to chipped, lead-based paint in families’ homes or yards.
But disease trackers found no problematic paint or other obvious source of lead at the home of the 6-month old.
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 his eyelids. His family believed that the powder, Tiro, would make the boy more attractive and improve his vision.
Now federal health officials are issuing an alert, prompted by the case, 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 case and highlights the large number of cultures in Asia, Africa, and the Middle East that use similar eye cosmetics that may contain lead. The products include kohl from Arab countries and surma or kajal from India and Pakistan.
In the case of the Nigerian eye powder, also known as tozali or kwalli, the CDC said it has been used in that country to “ward off the evil eye”; to relieve eye strain, pain, or soreness; and to prevent infection in infants after the umbilical cord is severed.
CDC officials advised obstetricians, pediatricians, midwives, and other health care professionals to discuss potential health risks 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, health officials said.
Dr. Alan Woolf, a coauthor of the report whose Children’s Hospital clinic treated the Nigerian child last year, said immigrant families who use these products typically get them from relatives who bring them from their native countries when they visit. He said some also buy them at ethnic specialty shops and on the Internet.
The baby boy was treated, and doctors said he suffered no apparent harm.
The state Department of Public Health is contracting with local agencies across Massachusetts that have staff of Nigerian, Asian, Indian, and other backgrounds who can explain the cosmetics’ health risks to immigrants in their own languages.
“People don’t want to believe that something that is so important for religious and cultural reasons would have a harmful effect on them,” said Suzanne Condon, director of the state Bureau of Environmental Health. “If we don’t send the message the right way, then there is the potential for the practice to go underground.”
The CDC recently halved the blood levels of lead considered safe for children, and state health officials have been sending letters alerting physicians to the changes and advising them that they may want to recheck children who tested at levels that were previously considered safe but are above the new threshold, Condon said.
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.
“The parents said it is quite common in some parts of their section of Nigeria for some families to use this as a beauty aid,” said Woolf, a pediatrics professor at Harvard Medical School and director of the hospital’s Pediatric Environmental Health 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 cultures that routinely use folk remedies and herbs that are unfamiliar to physicians trained in Western medicine and that contain high levels of lead and other heavy metals, such as arsenic, that are harmful.
One case involved a child whose family was from Thailand and had been using a traditional Thai treatment 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.
The 1-year-old’s lead levels were so high that he needed to be hospitalized to have the chemical leached from his body. Woolf said he did not appear to have developmental delays, but the family did not continue with treatment in his office, so he does not know whether the child developed problems later.
“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,” Woolf said, “but there should be a special awareness by health care providers” of potential risks.
At Boston Medical Center, which cares for many immigrant patients, Dr. Rob Saper directs a program called Integrative Medicine and Health Care Disparities, which 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.”
Saper said he has encountered patients from India who use kohl, another eye cosmetic with high lead levels, for religious or ceremonial purposes on children and adults. He tells patients that some alternative therapies, such as yoga for lower back pain, can be helpful, but that others can be harmful.