Surma: A significant source of lead poisoning among children in San Joaquin County | Families

STOCKTON, CA (January 9, 2013) –  Dr. Judy Cook, San Joaquin County Public Health Services Children’s Medical Services Director, warns parents and families of all young children that using surma, kohl, or kajal on the eyes of young children may cause brain damage.   “We now know there is no safe level of lead exposure in children,” says Gale Heinrich, Coordinator of San Joaquin County’s Childhood Lead Poisoning Prevention Program (CLPPP).  “Even low levels of exposure cause lead to accumulate in the blood and can cause lifelong learning and behavioral problems.”

Lead is a toxic heavy metal that can result in serious and permanent damage to the brain, nervous system, and kidneys causing learning and behavior problems and anemia.  The most common ways for children to become lead poisoned are through ingestion or inhalation of lead contaminated products.  Surma, kohl, or kajal are often applied to the eyes of infants and young children for cosmetic purposes.  Children become lead poisoned when they put their hands in their mouth after touching their eyes.   Using these products is a valued cultural practice in many countries in South and Central Asia, Africa, and the Middle East.  These products are believed to protect the eyesight and vision, make the eyes more beautiful, or ward off the “evil eye.”    Of the 44 San Joaquin County lead exposure cases Heinrich is currently following, 14 (31 percent) are related to the use of surma.  Of these 14 cases, the majority are from families originating from Pakistan.

“Lead is especially dangerous to young children,” says Heinrich.  “The symptoms aren’t usually obvious when the exposure occurs and are sometimes confused with common childhood complaints such as stomach aches, crankiness, headaches, or loss of appetite.”

Commercial preparations of surma, kohl, or kajal may contain more than 70 percent lead.  Surma associated with a case in San Joaquin County last year was analyzed and found to be 74 percent lead.  The U.S. Food and Drug Administration has banned surma, kohl, and kajal from import into the United States, but these products often still make their way into the country in the suitcases of travelers or by illegal import and distribution to retailers.

San Joaquin County’s Childhood Lead Poisoning Prevention Program recommends that all children under the age of six be tested for lead exposure.  Heinrich also advises parents to ask their healthcare providers specifically for the simple blood test.  “Many doctors are not aware of the cultural sources of lead, so parents need to be pro-active.”

Parents whose children have been exposed to surma, kohl, or kajal should contact their physician about getting a blood lead test as soon as possible.  The earlier lead levels are detected, the more successfully they can be treated and lowered.  For more information about lead or lead testing, please contact Gale Heinrich, Coordinator, San Joaquin County Childhood Lead Poisoning Prevention Program, 209-468-2593.