FLINT, Mich. >> Quayana Towns’ 2-month-old daughter wriggled on an exam table last week as her pediatrician ticked off questions that have become essential for every parent of young children here.

“So what are you guys doing for water — what are you drinking?” asked the doctor, Mona Hanna-Attisha.

“I have a whole bunch of bottled water that I picked up,” said Towns, 26, assuring the doctor that the family had been drinking it for a few months, since the gravity of Flint’s water crisis came to light.

“And before that you were using tap water?”

“Yes,” Towns replied, as her other child, a 1-year-old, King, toddled around.

Hanna-Attisha would waste no time adding King and his sister, Taeyana, to a new database of children under 6 who may have been exposed to lead in Flint’s water, a group she said she believes could number 8,000.

Of all the concerns raised by the contamination of Flint’s water supply, and the failure of the state and federal governments to promptly address the crisis after it began nearly two years ago, none is more chilling than the possibility that children in this tattered city may have suffered irreversible damage to their developing brains and nervous systems from exposure to lead.

Residents and advocates have expressed outrage over the government’s failure to protect Flint’s children, something many of them say would not have happened if the city were largely white. Adding to their injury, they say, are the harsh conditions of poverty that have already placed ample obstacles in their young lives.

At the same time, many are turning their attention to the future, when the effects of consuming lead-laced water for months may be all too evident.

At the center of those efforts is Hanna-Attisha, whose research documenting a spike in children’s blood lead levels forced dismissive government officials to finally acknowledge the water crisis last fall. With her colleagues at Hurley Children’s Hospital, where she directs the pediatric residency program, she is at the forefront of the scramble to put in place the services and resources so that every child who needs extra help learning or overcoming medical problems will have support for years to come.

Decades of research have found that exposure to even low levels of lead can profoundly affect children’s growth, behavior and intelligence over time. Studies have linked elevated lead levels in blood to learning disabilities, problems with attention and fine motor coordination, and even violent behavior.

Younger children and fetuses are especially vulnerable because of their developing brains and nervous systems, which is why the efforts here will focus on children 5 and younger.

Emails released by the office of Gov. Rick Snyder last week referred to a resident who said she was told by a state nurse in January 2015, regarding her son’s elevated blood lead level, “It is just a few IQ points. … It is not the end of the world.”

Hanna-Attisha and others who have studied lead poisoning have a sharply different view of lead exposure, for which there is no cure.

“If you were going to put something in a population to keep them down for generations to come, it would be lead,” Hanna-Attisha said.

Underlying the problem are the troubling conditions prevalent among low-income children and their families in cities like Flint: spotty access to doctors and health care services; a dearth of healthy foods; living conditions so poor that many of the children may have already been exposed to lead poisoning from the paint in their homes; parents with limited time and financial resources.

The doctors here said they will focus on improving the diets of affected children and expanding education programs like Head Start, the federally funded preschool program for low-income children, which already has a waiting list in Flint. Hanna-Attisha has submitted dozens of recommendations to the governor, state legislators and federal officials.

It remains a wish list at this point, but she and others believe that with Flint’s public health crisis in the national spotlight, the city’s chances of getting help are better than ever before.

Snyder and the state Legislature have so far allocated $28 million in emergency state spending for Flint. Some of the money will provide initial services, like health assessments and home visits from nurses, to lead-exposed children. Snyder has also asked the federal government to expand Medicaid to cover every Flint resident younger than 21, regardless of income level. And Democrats in Congress said Thursday that they would seek $600 million in federal aid for Michigan to help Flint.

Local philanthropic groups have set up a charitable fund with the goal of improving health outcomes for children exposed to lead, including through Hanna-Attisha’s project, the Pediatric Public Health Initiative. Psychologists, nutritionists and child development experts are among the participants in the project, which Hurley is overseeing with Michigan State University’s College of Human Medicine, where Hanna-Attisha is an assistant professor of pediatrics.

“We have a unique opportunity to build a model public health program here,” Hanna-Attisha said. “We have to throw every single evidence-based resource at these kids, starting now.”

It is impossible to gauge how each child will be affected, partly because the developmental effects of lead poisoning may take years to emerge. A flurry of lead testing has taken place since October, when the Genessee County Health Department finally declared a public health emergency. The agency told residents to stop drinking the water, which was coming from the Flint River, rather than Lake Huron, in an attempt to save money.

Experts say the testing may provide false reassurance. Most residents have probably switched to drinking bottled water, and since lead can be detected in the blood for only about a month, the test results may not reflect the extent of their exposure.

“Our kids are already rattled by every kind of toxic stress you can think of,” Hanna-Attisha said. “Every single day in our clinic we have a 40 percent no-show rate, and it’s not because parents don’t love their children. It’s because they can’t get here and can’t get past every other obstacle to day-to-day living.”

She emphasized, however, that not every child exposed to lead would suffer ill effects. Kim Dietrich, a professor of environmental health at the University of Cincinnati College of Medicine, said that based partly on the blood lead levels of children in Hanna-Attisha’s study, he did not think serious long-term health problems would be widespread.

About 57 percent of Flint’s 99,000 residents are black, and 40 percent live in poverty, one of the highest rates in the nation for a city its size. Bilal Tawwab, the superintendent of the city school system, said that one school nurse currently serves the 5,400 students in the district, but that he hoped some of the money flowing into Flint might help open health centers in every school.

He also hoped to make prekindergarten available to every 4-year-old — spaces are currently limited — and to hire more experienced teachers for special education.

“That’s the piece that keeps me up at night,” he said. “It costs almost double to educate a student with special needs. And our wages, our salaries, are so low.”

Ruth Ann Norton, executive director of the Coalition to End Childhood Lead Poisoning, based in Baltimore, said that even children who get intensive educational help after lead exposure may face lifelong obstacles.

“Even kids who are able to get through school, and even to get to college, they struggle,” she said. “And I will tell you that they are exhausted.”

Hanna-Attisha and other pediatricians here are urging families to feed their children foods rich in calcium, iron and vitamin C, which can help minimize the amount of lead their bodies absorb. Yet that raises another problem: Flint is a food desert, with no large grocery stores within the city limits.

Hanna-Attisha said that while lead is the primary concern, the researchers are also concerned about the effect of total trihalomethanes, or TTHMs, chemical compounds that were found in Flint’s water after city officials pumped extra chlorine into the system to address bacteria problems after the switch to river water. Some studies have linked TTHMs in water to higher miscarriage rates.

Many people in Flint have had skin irritation and rashes over the past 18 months, which Hanna-Attisha now attributes to the extra chlorine and TTHMs in the water. Because they were slow to make the connection, she and other local doctors are trying to make up for it, with checkups for young children presenting a prime opportunity.

At Taeyana’s appointment, Hanna-Attisha held the baby’s face close to hers as she rattled off instructions that were the same as she had been giving for years, but were more urgent now.

“Her brain is growing so much from now until she’s 2,” she told Towns, “so this is when you want to read to her and sing to her and smile at her and tell her what you’re doing every minute.”

The family would return next week for King’s checkup, and his first lead test.

For now, Towns is focused on getting through each day, making sure she has enough bottled water to prepare formula for Taeyana every two hours.

“Instead of them donating all this water, what can they do about the pipes?” she asked. “What can they do?”

© 2016 The New York Times Company