We realize physicians and healthcare providers are incredibly busy! This page provides guides and reference material for identifying and following up on pediatric elevated blood lead levels. Nevada ranks near the bottom of US states in childhood blood lead level testing, with as few as 3% of children tested annually. The following information provides guidance and best practices to identify, treat, and report incidences of pediatric elevated blood lead levels. Providers should confirm all blood lead levels of 5 μg/dL or greater from venous blood draws. Lead test reporting is required for medical professionals by Nevada law. . .
CDC Guidelines for Testing for Lead in Children
Testing recommendations from the Centers for Disease Control and PreventionThere 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
- at least once before age 6 if not previously tested
- Guidelines for Testing by Coverage Type
- Council of State and Territorial Epidemiologists Definition
- Additional Screening Recommendations
Guidelines for Testing by Coverage Type
Council of State and Territorial Epidemiologists Definition
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. Case Classification
- 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.
Additional Screening RecommendationsCurrently, screening rates for blood lead levels in children 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 accord 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 children’s age. Providers of non-Medicaid eligible children 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 chip or object that might contain lead
- Perform a blood lead test for children 6 months to 16 years within 30 days of entry to the US
- Within 3-6 months of initial test, conduct a follow-up test for children 6 months to 6 years, regardless of the initial test result
- Consult US CDC screening guidelines for children who are immigrants and refugees
Methods for Conducting a Blood Lead Level Test in Children
Providers have the option of screening via capillary test or traditional venous draw.Capillary blood analysis may be completed using a CLIA waved in-office testing device such as the Magellan LeadCare II device and directly reporting the results to the local health authority. All capillary screening results must be reported to the local health authority per NRS 441A. For help obtaining an in-office capillary blood lead testing device, contact the NvCLPPP at 702-895-1040. Higher capillary test results necessitate the urgent need for venous test confirmation. Venous test results are required to access health authority services. .
Capillary Test Confirmation Schedule
|Capillary Blood Lead Level||Confirm with Venous Test Within*|
|5-9 µg/dL||3 months|
|10-44 µg/dL||1 month|
|45 -59 µg/dL||48 hours|
|60-69 µg/dL||24 hours|
|70+ µg/dL||Immediately as an emergency test|
Notification of the local health authorityIn the state of Nevada lead exposure is a reportable condition by law. Per NRS 441A, reports of specified diseases, outbreaks, and extraordinary occurrences of illness MUST be made to the local health authority. This law requires physicians, registered nurses, and directors of medical facilities report lead exposure and elevated blood lead levels as events of concern. Failure to report is a misdemeanor and subject to an administrative fine of $1,000 for each violation. Provider Disease Reporting may be accomplished by contacting your local health authority through the following methods.
- (Preferred) Electronic Southern Nevada Health District (SNHD) Reporting Form
- Telephone Southern Nevada Health District 702-759-1300
- Fax the Nevada Confidential Morbidity Report Form to 702-759-1454
- For more information on how to report blood lead results to the SNHD, view this PDF guide on how to upload blood lead results in Clark County or select one of the videos below:
- Telephone Washoe County Health District 775-328-2447 or Email email@example.com
- Fax the Nevada Confidential Morbidity Report Form to 775-328-3764
- Telephone Carson City Health & Human Services 775-887-2190
- Fax the Nevada Confidential Morbidity Report Form to 775-887-2138
- Telephone Nevada Division of Public and Behavioral Health 775-684-5289
- Fax the Nevada Confidential Morbidity Report Form to 775-850-1144
How to Respond to an Elevated Test. Back To Top . .
Referral Sources for Parents
Resources for education and lead-safe homesServices are available for families of children with elevated blood lead levels to evaluate and place them into programs appropriate to their level of ability. The Southern Nevada Health District provides a full lead investigation of a child’s home environment when a venous blood lead test result is 5 μg/dL or greater. Nevada Early Intervention Services (NEIS) provides an evaluation of children’s development and services to children 3 years old and younger at no cost. dhhs.nv.gov/programs/idea/early_intervention_programs Clark County 702-486-7670 Washoe County 775-688-1341 Carson City 775-687-0101 Statewide 1-800-522-0066 Child Find Department offers services for children age 4 and older through the family’s local school district at no cost. dhhs.nv.gov/programs/idea/projectassist/local-resources Clark County 702-799-7463 Washoe County 775-327-0685 Las Vegas Lead Hazard Control and Healthy Homes Program offers free lead risk assessments to qualified residents who meet eligibility requirements and have a pregnant woman, child, or visiting child in the home. If lead is found, LVLHCHHP will conduct a more in-depth healthy homes assessment of the dwelling to identify hazards that may be remediated, such as broken air conditioners, windows, door locks, plumbing issues, and more. The program will then make repairs to the home to make it healthier and safer at no cost to the home’s owner or occupants. Rental units are also eligible. Additionally, the program offers free blood lead testing to children under 6. Services Offered
- Lead-based paint and healthy homes assessments
- If a lead hazard is found:
- Repair or removal of lead-based paint
- Home repairs (electrical, plumbing, windows, etc.)
- Blood lead testing for young children