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…
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 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
- 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
|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
2. If previously tested: Blood lead test yearly unless annual risk assessment questionnaire is negative.
|Yearly blood lead test unless annual risk assessment questionnaire|
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.
- 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 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
Recommended Testing Schedule for Recently Arrived Children Who Are Refugees
- 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 authority
In 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.
- Electronically (Preferred) SNHD Reporting Forms https://www.southernnevadahealthdistrict.org/diseasereports/forms/disease-reporting
- Telephone Southern Nevada Health District 702-759-1300
- Fax the Nevada Confidential Morbidity Report Form to 702-759-1454
- Telephone Washoe County Health District 775-328-2447 or Email firstname.lastname@example.org
- 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
|BLL Test Results
|Venous Confirmation Retest Within||Recommended Actions based on BLL||Venous Retest –
After Recommended Actions
|< 5||None||• Provide dietary counseling (calcium & iron) and environmental education
• Follow-up blood lead monitoring at recommended intervals
|Retest according to
Blood Lead Screening Plan
|5 – 9||3 mo||Above Actions, plus:
• Complete history and physical exam
• Lab work: iron status, hemoglobin, hematocrit
• Refer to health department for environmental investigation
• Recommend lead hazard reduction in home
• Neurological, behavioral, and developmental monitoring
• Abdominal x-ray (if lead ingestion is suspected with bowel decontamination)
• Environmental assessment to identify potential lead sources
|3 months for first 2 – 4 tests
6 – 9 months after BLL are declining
|10 – 19||1 – 3 mo||1 – 3 months for first 2 – 4 tests
3 – 6 months after BLL are declining
|20 – 24||1 – 3 mo||1 – 3 months for first 2 – 4 tests
1 – 3 months after BLL are declining
|25 – 44||2 wk – 1 mo||2 weeks – 1 month for first 2 – 4 tests
1 month after BLL are declining
|45 – 59||ASAP
|Above Actions, plus:
• Environmental investigation of the home and lead hazard reduction
• Oral chelation therapy
• Consider hospitalization if lead-safe environment cannot be assured
|Every 24 hours
or as medically indicated
|Every 24 hours
or as medically indicated
|60 – 69||ASAP
|≥ 70||Stat as emergency test||Above Actions, plus:
• Hospitalize and commence chelation therapy in conjunction with consultation from a medical toxicologist or a pediatric environmental health specialty unit
|Every 24 hours
or as medically indicated
Referral Sources for Parents
Resources for education and lead-safe homes
Services 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.
Clark County 702-486-7670
Washoe County 775-688-1341
Carson City 775-687-0101
Child Find Department offers services for children age 4 and older through the family’s local school district at no cost.
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.
- 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
To qualify, dwellings must be in the following zip codes: 89101, 89102, 89104, 89106, 89107, 89108, 89109, 89110, 89117, 89124, 89128, 89129, 89130, 89131, 89134, 89138, 89143, 89144, 89145, 89146, 89149, 89166.
Materials to raise awareness
NvCLPPP offers lead hazard education materials free for display and distribution in your office! The available materials include professionally printed, full-color posters, trifold brochures, and handouts available in English and Spanish. To order, call 702-895-1040 or email Erick.Lopez@unlv.edu
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