Testing for Lead: WA’s blood lead testing is one of lowest in the US.

Leigh Cullen, MPA, Childhood Lead Poisoning Prevention Program, WA Department of Health

While childhood lead poisoning in Washington state is less common than it once was, unfortunately it is not just a thing of the past. Children are particularly susceptible to the damaging effects of lead, especially those six years old and younger who have sensitive, growing brains and nervous systems. Children are often asymptomatic despite having elevated blood lead levels.

Testing for lead in the blood is the only way to find out if a child has been exposed, so it is crucial to include a blood lead test in well-child visits. Unfortunately, Washington state’s blood lead testing rate is one of the lowest in the country. In 2018, only 4% of children under age 6 were known to have been tested for lead compared to the national average of 18%. With testing rates so low, it is difficult to determine how many children in our state are getting exposed to lead.

Approximately 47 percent of housing in Washington state was built before 1980, and homes built before 1978 are likely to have lead-based paint. Swallowing paint chips or breathing lead dust from the home and/or surrounding soil are the primary sources for lead exposure in children. Given the large proportion of older housing and low childhood blood lead testing rate, it is likely that many children’s exposures to lead go unnoticed.

Federal regulations require that all children covered by Medicaid receive a blood lead test at 12 and 24 months of age, or at 24 to 72 months of age if no record of a previous test exists. For all children not covered by Medicaid, we recommend screening at 12 and 24 months of age using this clinical algorithm, To determine if a child should receive a blood lead test. This algorithm and other lead education materials are available on the DOH Lead Publications page.

All blood lead test results (non-elevated and elevated) must be reported to DOH by the lab that analyzed the sample (or your clinic if you use a point-of-care machine) as required by the Notifiable Conditions Washington Administrative Code (Chapter 246-101 WAC). Blood lead levels at or above 5 μg/dL need to be reported within 48 hours of testing; blood lead levels below 5 μg/dL need to be reported within 30 days. Local Health Jurisdictions receive all test results and are primarily responsible for follow-up.

For questions about lead exposure, testing, reporting, or the notifiable conditions rules, contact the Childhood Lead Poisoning Prevention Program at (360) 235-4280/(800) 909-9898 or email lead@doh.wa.gov.