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Laboratory Tests: Lead Screening

*

Childhood lead poisoning is the most common environmental disease in children younger than 6 years of age in the United States. Lead screening and prompt intervention in early childhood help reduce the risk of learning disabilities, attention deficits, hyperactivity, and behavioral disorders caused by elevated lead levels. Only a small percentage of children in the District are documented to be receiving blood lead screenings at the appropriate intervals. In response to this, the District is committed to improving this percentage.

NEW! Read the October 2010 letter from the District's Departments of the Environment, Health, and Health Care Finance to health care providers regarding the importance of lead screening.

 

Periodicity and Guidelines for Lead Screening

*Lead screening periodicity and guidelines can be summarized as below. For more information, contact the DC Lead Poisoning Prevention Division at (202) 535-2634 or 535-1394.

All children covered under Medicaid should receive 2 blood lead tests.

  • District law requires all Medicaid-enrolled children receive a lead test at least twice: first between ages 9 and 14 months, and a second time between ages 22 and 26 months.1
  • In addition, if there is no documentation of previous lead screening, federal law requires that all Medicaid-eligible children between the ages of 36 and 72 months of age also receive a screening blood lead test.2
  • All other children 36-72 months require a test unless assessed as low lead risk. Lead level of concern: greater than or equal to 10 ug/dL.3

NOTE: These requirements comply with federal law requiring that all children covered under Medicaid receive a screening blood lead test at 12 months and 24 months of age. Children between the ages of 36 months and 72 months of age must receive a screening blood lead test if they have not been previously screened for lead poisoning.4

 

Screening Guidelines

  • The DC Lead Poisoning Prevention Division requires venipuncture technique for all blood lead samples.
  • Send blood lead samples to a recommended laboratory (see below).
  • Confirm with a venous blood sample any test result greater than or equal to 10 micrograms per deciliter (dl) of blood.
  • If blood lead level is greater than or equal to 10 micrograms/dl, screen with a blood test at each preventive health visit through 6 years of age.
  • Continue to assess risk and provide guidance on reducing lead exposure.
  • Document all test results and guidance in the child's medical record.

 

Lead Risk Assessment and Health Education

Although lead screening is mandatory in DC, it is important to assess possible sources of lead in the child's environment and to educate families on ways to reduce lead exposure. Use the following resource tool to assess lead risk, then provide targeted health education.

Verbal Lead Risk Assessment5

  • Has your child been diagnosed with lead poisoning (elevated lead level)?
  • Are there any children with a current or past history of lead poisoning living in or regularly visiting your home?
  • Does your child live in or regularly visit a home with chipping or peeling paint?
  • Does your child eat dirt or cigarettes or fireplace ashes, or chew on old metal or painted toys?
  • Have you seen your child chewing on paint chips or painted surfaces (doors, railing, window sills, etc.)?
  • Does your child live in or regularly visit a home with recent, ongoing, or planned renovations or remodeling?
  • Do you or any other adults in your home have a hobby that involves lead (i.e., furniture refinishing, home renovations, construction work, or automobile repairs)?
  • Do you regularly store food or liquid in pottery, ceramic dishes, or previously opened metal cans?
  • Does (or did) your child regularly live in or visit a home near an active lead smelting plant, battery recycling plant, or industry likely to release lead?

 

Screening Newly Arrived Refugee Children6

The Centers for Disease Control and Prevention recommends:

  • Screening recently resettled refugee, immigrant, and internationally adopted children ages 6 months to 16 years, upon arrival in the U.S.
  • Repeat screening of all refugee children 6 months to 6 years of age 3 to 6 months after placement in a permanent residence

 

Resources

 

References

1 District law requires additional screening, beyond ages one and two, when circumstances justify it. For example, when a child lives in or frequently visits housing build before 1978 with recent, ongoing, or planned renovation or remodeling, DC regulations require that additional blood lead screening occur, even if the child has already been screened twice. See DC Municipal Regulations ยง 22-7301.3.

2 Section 1905(r) of the Social Security Act requires additional screening for Medicaid-eligible children if there is no documentation of previous screening.

3 Language taken from the back of DC HealthCheck Standard Medical Record Forms Numbers 4-5.
Available online at http://dchealthcheck.net/resources/healthcheck/smrf.html.

4 CMS State Medicaid Manual, Section 5123.2(D)(1).

5 Risk Assessment questions are based on Centers for Disease Control and Prevention. 1997. Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials. Atlanta, GA: CDC. Available online at http://www.cdc.gov/nceh/lead/guide/1997/PDF/c2.PDF.

6 CDC Lead Poisoning Prevention in Newly Arrived Refugee Children: Tool Kit see Medical Provider Module.

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