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The Importance of Blood Lead Screening in Children

Date: 04/23/25

Lead is one of the top environmental exposures affecting children in the U.S. Children under the age of 6 years old are at a greater risk for lead poisoning. This is because they are growing rapidly and tend to have behaviors that increase the potential for exposure to lead sources. They are also more susceptible to the health effects of lead poisoning. In fact, even low levels of lead in the blood have been shown to affect IQ, delay development, cause behavioral problems, and cause other serious health effects.

The Consumer Product Safety Commission banned lead-based paint from homes in 1978, and lead was phased out of gasoline from 1973 to 1986. Even with these improvements, all children need to be protected from exposure to lead. Lead-based paint and lead-contaminated dust are the most hazardous sources of lead for children. While lead-based household paints were banned in 1978, many homes built before then still have lead-based paint. That paint becomes especially problematic when it deteriorates. Lead-based paint, however, is not the only sources of lead that children are exposed to. Other sources of lead exposure include:

  • Soil near old homes and/or busy streets
  • Imported candy, herbs, spices and cosmetics
  • Imported natural remedies and ceremonial substances
  • Ammunition, guns, shooting ranges
  • Older water pipes and plumbing
  • Dishware
  • Art like stained glass and pottery
  • Children’s toys and toy jewelry
  • The workplace and hobbies (welding, battery manufacturing, soldering, etc.)

One out of every 14 U.S. children tested has lead levels that are high enough to damage their health.

In 2021, a study by Quest Diagnostics and Boston Children’s hospital reported one in every two children had detectible levels of lead in their blood.

  • All children should be screened for lead risk factors at each well child visit between 6 and 72 months of age. This can be completed through the Blood Lead Screening Questionnaire.
  • Testing is required by 12 and 24 months for all members enrolled in Medicaid, via blood sample (capillary or venous). All Medicaid-enrolled children should receive a blood lead test before 6 years of age, if they have not had one previously.
  • If one child in the home has an elevated blood lead level, all other children and pregnant or lactating women residing in the home should be tested for lead.
  • If a child is known to have or suspected of having PICA, a lead screening should be completed.
  • KDHE has requested that all children with a blood lead level (BLL) ≥10, by venous draw, be assigned a case manager by the assigned MCO.
  • An elevated capillary test needs to be confirmed with a venous test. If capillary testing detects lead but no lead is detected in the venous sample, then the home environment should be assessed for lead hazards.
  • Children with elevated blood lead levels should obtain baseline iron studies and should include CBC, serum Ferritin, TIBC, iron saturation and FEP (free erythrocyte protoporphyrin).
  • Patients should continue to be screened for risk factors annually and tested if they screen “yes” or “don’t know” for any risk factors.

Testing and Medical Management Recommendations

For capillary test results (unconfirmed elevated blood lead levels):

Capillary test results should be confirmed with a venous test right away, preferably within one week, but no more than the following timelines:

  • 3.5-9.9 µg/dL - Venous confirmatory test within three months
  • 10-44.5 µg/dL - Venous test within one week to one month, higher levels should test sooner
  • ≥45 µg/dL - Immediate confirmatory venous test and contact the Poison Control Center and KDHE

For venous test results (confirmed elevated blood lead levels):

  • 3.5-23.9 ug/dL – Venous test within 1-3 months, higher levels should test more frequently
  • 25-44.9 ug/dL - Venous test within 2-4 weeks
  • 45-59.9 ug/dL - Venous test within 48 hours
  • 60-69.9 ug/dL - Venous test within 24 hours
  • 70+ ug/dL - Venous test immediately

The KS Childhood Lead Poisoning Prevention program considers the case resolved once a child has received two consecutive blood lead tests with results <3.5 µg/dL within 12 weeks of each other.

For More information and Resources: Refer to Kansas Childhood Lead Poisoning Prevention Program at  www.kdhe.ks.gov/1107/Childhood-Lead-Poisoning-Prevention.

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