Lead Screening Resources

Image of a blood level test

Welcome

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.

Key Resources

Use this landing page to access requirements, guidelines, and additional resources:

DC Lead Registry Information and Training Video

Training Video. This DC Lead Registry Demo training was held on September 30, 2021, in collaboration with CRISP DC and the Department of Energy and Environment (DOEE) on the use of the newly launched CRISP DC Lead Registry. This new and innovative registry will allow providers, who have access to CRISP DC, a quick and easy way to check the lead screening status for their patients and be alerted regarding elevated blood lead levels (BLLs). This demo video covers the functional use of patient search, health records, and care alerts. Also see the accompanying DC Lead Registry User Guide. For more information on the registry, contact Emmanuel C. Ofoche at Emmanuel.ofoche@dc.gov. For access to the DC Lead Registry via CRISP, email J'Marshanae Rush at Shanae.Rush@crisphealth.org.

 

Periodicity and Guidelines for Lead Screening

Lead screening periodicity and guidelines is summarized as below. For more information, contact the Lead-Safe and Healthy Housing Division at (202) 535-2600.

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 6 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.  All other children 36-72 months require a test unless assessed as low lead risk. Lead level of concern: greater than or equal to 5 ug/dL.2

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.3

Remember to consult and follow the DC Medicaid HealthCheck Periodicity Schedule.

Also, don't forget to add the two mandated blood lead screening test results to the DC Universal Health Certificate.

Screening Requirements and Guidelines

Screening Requirements from Transmittal 22-36 - Lead Cover FY23:

District law requires that every child who resides in the District of Columbia receive a blood lead level (BLL) screening test between 6 months and 14 months of age and another BLL screening test between 22 months and 26 months of age, unless an identical test has already been performed in the previous 12 months. Missed opportunities in well-child visits to screen “Every Child, Twice by Two” leave children in the District at risk for serious and irreversible harm from lead exposure. In addition, if a child over 26 months of age has not been tested, the law requires BLL testing at least twice before the child is six years of age.

District law also requires you to screen for lead when a child is at risk for high-dose lead exposure. Risk indicators include living in or frequently visiting deteriorated or renovated housing build before 1978, which by District law is presumed to include lead-based paint; having a household member who may be exposed to lead at work; or having neurological, behavioral, developmental, or other symptoms consistent with lead exposure.

Additional Guidelines:

  • The Lead-Safe and Healthy Housing 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 3.5 micrograms per deciliter (dl) of blood.
  • If blood lead level is greater than or equal to 3.5 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.

Reporting Requirements

Reporting Requirements from Transmittal 22-36 - Lead Cover FY23:

For laboratories, including health care facilities that use point-of-care devices, District law requires reporting all blood lead level (BLL) test results to the Department of Energy and Environment (DOEE) within a week. Reports should include venous and capillary BLLs. District law also requires laboratories to report children with an elevated BLL at or above 3.5 micrograms of lead per deciliter of blood (ug/dL) immediately to DOEE.

For pediatric providers and health care facilities that receive laboratory reports indicating an elevated BLL in a child, District law requires you to inform DOEE within 72 hours. To allow DOEE to take prompt action through case management and risk mitigation for all elevated BLLs, laboratories, providers, and facilities are also asked to report BLL results at or above 5ug/dL to DOEE immediately. To report an elevated BLL, fax the result to DOEE’s secure fax line at (202)535-2607 or call DOEE at (202) 481-3837.

Also, don't forget to add the two mandated blood lead screening test results to the DC Universal Health Certificate.

Follow-Up Testing and Case Management Requirements

Follow-Up Testing and Case Management information from Transmittal 22-36 - Lead Cover FY23:

When a child has an elevated blood lead level (BLL), you are legally obligated to provide follow-up BLL testing, treatment, and care. Required care includes case management, such as family education, developmental screening, and referrals for social and environmental services. Under Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, you are also responsible for providing anticipatory guidance to pregnant women, parents/guardians, and their families about the protective steps they can take to prevent lead exposure. Visit http://doee.dc.gov/node/613342 for helpful guidance you can share with those you serve.

School Health Requirements

School Health Requirements from Transmittal 22-36 - Lead Cover FY23:

The updated District of Columbia Universal Health Certificate (UHC) now requires documentation by providers of the two blood lead level (BLL) screening test results for children less than six years of age. The UHC must be submitted annually for all children enrolled in child development facilities, Head Start, and public, public charter, private and parochial school in the District of Columbia. The UHC is available at https://dcps.dc.gov/page/school-health-requirements.

Lead Risk Assessment and Health Education

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 Assessment4

  • 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 Children

The Centers for Disease Control and Prevention recommends:5

  • 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

DC and National Lead Resources (including Lead Transmittal)

Learn More

LOG-IN to access lead screening training information and additional 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 § 22-7301.3.

2 CDC. What Parents Need to Know to Protect Their Children? https://www.cdc.gov/nceh/lead/acclpp/blood_lead_levels.htm

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

4 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 https://www.cdc.gov/nceh/lead/guide/1997/PDF/c2.PDF.

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