Testing recommendations from the Centers for Disease Control and Prevention
There is no safe level of blood lead concentration. According to the CDC, children should be tested by venous blood draw for elevated blood lead levels at:
- 12 months
- 24 months
- Or at least once before age 6 if not previously tested
- Guidelines for Testing by Coverage Type
- Council of State and Territorial Epidemiologists Definitions
- Additional Screening Recommendations
Guidelines for Testing by Coverage Type
|Age||Children Covered by Medicaid and NV Checkup||Children Covered by Private Insurance|
|1 year (9-17 months)||Blood lead test mandatory||Blood lead test unless annual risk assessment questionnaire is negative|
|2 years (18-36 months)||Blood lead test mandatory||Blood lead test unless annual risk assessment questionnaire is negative|
|3-5 years (36-72 months)||1. If not previously tested: conduct blood lead test||Yearly blood lead test unless annual risk assessment questionnaire|
Council of State and Territorial Epidemiologists Definition of Lead Poisoning
Laboratory Criteria for Diagnosis Blood lead concentration, as determined by a Clinical Laboratory Improvement Amendments (CLIA)-certified facility, of ≥5 µg/dL (0.24 µmol/L) in a child (person <16 years of age).
Criteria to Distinguish a New Case from an Existing Case Counted once per year, regardless of the number of elevated blood lead levels in the same year.
- Confirmed One venous blood specimen with elevated lead concentration, or two capillary blood specimens, drawn within 12 weeks of each other, both with elevated lead concentration.
- Unconfirmed A single capillary or unknown blood specimen with elevated lead concentration or two capillary blood specimens, drawn greater than 12 weeks apart, both with elevated lead concentration.
- Case Classification Comments Elevated blood lead levels, as defined above, should be used as standard criteria for case classification for the purposes of surveillance but may not correspond to action levels determined by individual public health programs or by providers with respect to patient care.
Elevated BLL classification does not use any case classification categories other than “confirmed” and “unconfirmed”. The “unconfirmed” category identifies tested children with a potentially elevated BLL but where testing was inadequate to make that determination.
Additional Screening Recommendations
Currently, screening rates in Nevada for blood lead levels in children are lower than 3%, making it difficult to know the totality of pediatric lead poisoning in Nevada. Therefore, the NvCLPPP and CDC recommend universal screening as a method to adequately assess individual patient needs and population-level epidemiological data. However, at a minimum the NvCLPPP recommends:
Providers should screen all children in accordance with the CDC guidelines for blood lead to ensure the best health outcomes.
Providers should also screen children who are symptomatic or potential exposure to lead has been identified, regardless of the child’s age.
Providers for children not eligible for Medicaid or NV Checkup should – at a minimum – conduct a lead risk evaluation using the Childhood Lead Risk Questionnaire (CLRQ) to determine the risk of potential exposure during a healthcare visit if screening is not a viable option. The CLRQ was adapted from the Illinois Department of Public Health.
Children of all ages who are recent immigrants, refugees, or adoptees are more likely to have elevated blood lead levels and should be screened at the earliest opportunity. Additionally, children who live in lower socioeconomic areas may be at higher risk.
Consider a blood test, regardless of age, if children have any of the following conditions:
- Unusual oral behavior, pica, developmental delays, behavior problems, ADHD
- Unexplained illness such as severe anemia, lethargy, abdominal pain
- Ingestion of paint chips or object that might contain lead
Recommended Testing Schedule for Recently Arrived Children Who Are Refugees
- Perform a blood lead test for children aged 6 months to 16 years within 30 days of entry to the US
- Within 3-6 months of an initial test, conduct a follow-up test for children aged 6 months to 6 years, regardless of the initial test result
- Consult the US the CDC screening guidelines for children who are immigrants and refugees.