Hi. My name is Debra Brunk and I’m a family nurse practitioner. I have more than 30 years of experience in the field and I am happy to share with you today some information on the growth and development of your children. Lead is a metal that can cause health problems if we have too much in our body. We have heard about the problem of lead in the water in Flint, but lead can also be present in old paint, soil, ceramic cooking pots, toys, cosmetics and some home remedies. Adults also may be in contact with lead through their work or hobbies, like car repair, working with metals or ammunition. Although high lead levels can affect the health of adults, children and pregnant women are most at risk. In this video, we’ll talk about your child’s growth and development during the first few years of life. We’ll talk about how lead can affect growth and development if there is too much in the body, and things we can look at to see whether a child is growing and developing normally. By development, we mean how the child changes and is able to do more advanced activities and behaviors as they grow. It is important to note that blood tests only show very recent lead contact. After about a month, roughly a third of the lead will be removed from the body when the child goes to the bathroom, and the rest will be stored mostly in the bones and some in soft tissues, like the brain. If a child lived in an area where there were high levels of lead, it is important to continue to monitor for signs of problems, even when the water is safe and blood levels are normal. The first two years of a child’s life are very important for their growth and development. At birth, a baby’s head is a quarter of its adult size. It grows about 1 centimeter a month during the first year, and by 12 months, reaches about three-quarters or 75 percent of adult size. The most important things are to make sure that our children and pregnant mothers are not getting lead in their bodies and to check their blood lead levels. We also want to monitor babies’ and young children’s growth and development. And the way we do that is by looking for certain things that babies usually do at different ages. We look at communication, ability to use their hands, arms and legs, problem solving and how they act with others. During the first 6 months of your baby’s life, he will go from making gurgling sounds to repeating sounds back to you. He’ll start holding his head up while on his tummy for a few seconds, then pushing his chest off the floor with two hands, and later push all the way up to a crawl. She will go from grasping your finger to grabbing a small toy with all fingers. At first his gaze will follow a toy moving across 10 inches from his eyes, and then he will start reaching out for that toy. She may start to smile at you at about 2 months, and a few months later start acting scared or different with strangers. These are examples of things we look for to see that your baby is developing as expected. By age one, your child should be able to point to things he wants, walk beside furniture while holding on with one hand, pick up a cheerio, drop small items into a container, offer you a toy when you reach out and ask for it, and use both hands and legs equally well. By age two, your child should be able to put two or three words together to make a sentence, walk up or down stairs holding on with one hand, turn a page, try to climb up on a chair, and copy what she sees others doing, such as sweeping or combing their hair. By age three, your child should be able to point to a body part when asked, kick a ball without holding on, draw a line on a page, copy you putting four small objects in a row, and use a spoon to feed himself with little spilling. By age four, your child should be able to name three items in a category, such as cow, dog, cat, catch a ball with both hands, unbutton one or more buttons, identify the smallest of three circles, and wash and dry his hands without help. By age 5, your child should use four and five word sentences, throw a ball overhead, draw a figure with head, body, arms and legs, name five different colors, and take turns and share with other children. These are some of the behaviors that your doctor or nurse will be looking at. If you have any concerns about how your child is growing and developing, you should have your child checked by a doctor or nurse. There are many guides and tools that help us test children to make sure they are developing normally, and the earlier we find problems, the more helpful treatment will be. Some services are only available to children if started before a certain age, so it is important to not wait to have your child checked. There are many resources available to people who live in Flint for blood testing in children and adults, home water testing, bottled water and water filters. Also, if someone in your family continues to have high blood lead levels even with clean water, there are resources to check your home for lead in old paint, soil contamination, or other sources, and if found, to have it fixed. At the end of this program, we will give you a list of resources and phone numbers for these services. Remember, you can always call 2-1-1 for the latest information about the water and current service hours and locations. Can I let my children take tub baths? In most cases you can use unfiltered water to shower and bathe, but don’t allow water to get in kids’ mouths. Bath time should be used for bathing only, rather than allowing children to play in the water. There are water testing kits available for a free test to see if your home water is safe. If your home water has not been tested for lead, you should have your water tested. If your results show high levels, the water may not be safe and you will receive help and information about the use of water filters, and if very high, for example, you may be told how to prevent contact with lead during bathing and showering of infants, or to use bottled water only, among other recommendations. You can call Genesee County Health Department at (810) 257-3603 to check your home for free and for help if the test comes back high. You can also call the Michigan Department of Health and Human Services at (866) 691-5323. Is it safe to brush your teeth with tap water? You should use filtered tap water to brush your teeth or bottled water if you don’t have a filter. Filtered water should also be used to wash fruits and vegetables and for cooking. Boiling water does not get the lead out of water, and may actually increase lead levels in the boiled water so cook with or boil only filtered water. How often should I have my child’s blood tested? A lead level below 5 means there is a little lead in your child’s blood. Your doctor may suggest retesting your child within the next year to make sure the level does not go up. A lead level of 5 to 44 means that your child has had some contact with lead. Work with your doctor and local health department for help limiting your contact with lead, and to assist in finding the possible source of lead in the home or play areas. Your doctor may retest your child in one to three months to make sure the level does not go up. Levels above 44 require more intensive medical treatment and the child should immediately be referred to a doctor. If I don’t live in the zip code that was most affected, do I still need to be worried? Any child who had contact with Flint water, even if they don’t live in Flint, should be tested. If you attend school or church, spend time at a friends’ home or have spent time in Flint for any reason, you should be tested. If in doubt about the water safety in your neighborhood, call (888) 322-4453 for information. What about my child that is older than five? Older children should also be tested. Some of the things to look for in older children are changes in behavior, like being more angry, acting out, having a hard time sitting still or having trouble with schoolwork. If you are worried that maybe your child is showing some delay in development, or if your child has not had a checkup and lead test, these are places where you can take them for medical care. At the Burton Health Center an identification card or ID will be requested but not necessary for services. No documentation is needed and Spanish translation is available. The Free Clinic charges according to your income. You must not have any form of insurance coverage and you will be asked for a proof of income, if any, like a pay stub or a letter from your employer. At the Genesee Community Health Center, an ID is required, but there are health coaches to assist with getting one, and patients are seen without ID on a case-by-case basis. Any family in Genesee County worried about the development or health of their child up to age three can use Early On by calling (810) 591-KIDS. They provide testing and services if needed, like speech or physical therapy, wherever the child is, at home or in day care. They do not have a Spanish-speaking operator but there are people in their office that can assist with Spanish if you ask for it. For families with children’s ages three, four and five, Build Up Michigan (517) 373-9433 offers special education programs and support through the local school district. If you have a doctor or nurse that you usually see, make an appointment. Most insurances will cover it. For children who do not have a doctor or nurse they usually see, free lead testing is available through the Genesee Health Department at the Burton Health Center. ID is not needed, Spanish speaking is available and no insurance is needed. Call 211 for help with transportation. Also, many pharmacies offer lead testing for adults. Call 2-1-1 for locations and hours. Testing may also be done free or based on your income, at the following Federally Qualified Health Centers (FQHC). All children up to age 21 that were exposed to Flint water from 2014 on are able to receive Medicaid. Pregnant women and their children are also eligible. A Spanish-speaking worker is available on Tuesdays at Our Lady of Guadalupe church to help explain and apply for Medicaid. Our Lady of Guadalupe is also assisting with making ID cards to present where needed for services. Call the church office for information at (810) 787-5701. You can also call the Michigan Department of Health and Human Services for information or help filling out an application. There is an option for Spanish when you call. You can apply online and if you would rather apply in person, the Michigan Department of Health and Human Services can give you locations and hours for places to go for help. Medicaid coverage includes health care, testing, and special services. Medicaid will provide a case manager if needed. The case manager helps you get the services and information you need. If someone in your home continues to have high blood lead levels even with low to no lead in the water, you can have your home checked for free for other areas that can have lead, such as paint, dust, soil or faucets. There are also funds available to make repairs to get lead out. This service is for homeowners and renters. You do not need permission from your landlord to request services if there is a person in the home with a high lead level. You can also call Michigan’s Children’s Health Access Program for help getting services if your child continues to have high blood levels at (810) 953-2427. These are locations where you can pick up water, filters and filter replacements, kits for home water testing, and drop off your water test bottles. Water testing is free and no ID is needed for these services. Water resource centers are open daily from 9am to 9pm. Call (810) 787-6537 for help. Remember, you can dial 2-1-1 at any time for information about all services and resources. When you call, there is an option to request assistance in Spanish. We know how important the safety, health and happiness of your children are to your family and we hope that this information is helpful. Thank you.