Screening for Childhood Lead Exposure

Allison Browne, MPH
Health Services Consultant

Office of Environmental Public Health Sciences
Washington State Department of Health

Exposure to lead can cause serious damage to a child’s development. Lead can affect almost every organ and system in the body, including permanent damage to the child’s brain and nervous system. Most children with elevated blood lead levels (EBLLs) are asymptomatic, so performing a blood lead test is the best way to determine if a child has been exposed. Children living in or visiting older homes (pre-1978) with legacy lead-based paint are most at risk. Additionally, children with pica behavior increase their exposure risk.

Lead Risk Factors

Children should receive a blood lead test if they:

  • Live in or regularly visit a house built before 1950
  • Live in or regularly visit a house built before 1978 that has had recent renovations
  • Are from a low income family (<130% of the poverty level)
  • Have a sibling or friend with an EBLL
  • Are a recent immigrant, refugee, foreign adoptee, or child in foster care
  • Have a parent or caregiver who works professionally or recreationally with lead
  • Use traditional, folk, or ethnic remedies or cosmetics

Federal law mandates testing for all children on Medicaid at ages 12 and 24 months.

Children may also be tested if their parents have any concern or request testing.

Blood Lead Test Reporting

There is no safe level of exposure to lead. According to the Centers for Disease Control and Prevention, the current blood lead level of reference at which public health action should be taken is ≥5 µg/dL. All blood lead test results are required to be reported to the Washington State Department of Health (DOH) per WAC 246-101-201.

Laboratory results must be reported within:

  • 2 business days if the blood lead level is >5 µg/dL
  • 1 month if the blood lead level is <5 µg/dL

Resources for Children with Elevated Blood Lead Levels

WA DOH can provide support for families with children who have EBLLs. When an elevated blood lead result is reported, DOH or the local health jurisdiction (LHJ) will coordinate with the child’s healthcare provider to determine a plan to reduce the child’s blood lead level. As part of this plan, DOH or LHJ may conduct a home visit and assessment to identify and remediate the source of lead exposure. Families may also be connected with nutrition services, such as the Women, Infants, and Children program, as well as other developmental programs to support the child’s health.


Clinical Algorithm for Targeted Childhood Lead Testing

Medical Management of Childhood Lead Exposure and Poisoning

Blood Lead Test Reporting

Lead Exposure Risk Map