Blood Lead Testing Of Children

A blood lead test is the only way to find out if a child has a high lead level. Most children with high levels of lead in their blood have no symptoms. Although lead hazards in pre-1978 housing are the most common risk to young children, lead can be found in many products and places.

A child’s risk of exposure changes rapidly as they become more mobile. One test does not rule out future exposure. It is very difficult to predict if a child has been exposed to lead by using a questionnaire.

The Iowa Department of Health and Human Services has recently updated its screening tool and blood lead testing guidelines to recommend that all children in Iowa get a blood lead test at 1 and 2 years of age.  Medicaid requires a blood lead test for all Medicaid enrolled and eligible one and two-year old children, while the Center for Disease Control & Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend testing for all one and two-year old children. The screening tool should be used for all children during well child visits between 6 months and 6 years of age. This testing and risk assessment schedule is in alignment with that of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT).

NEW - Updated Screening Tool and Blood Lead Testing Recommendations for Children 12 and 24 Months of Age:

In partnership with the Iowa Institute of Public Health Research and Policy and the Childhood Lead Advisory Workgroup (CLAW), the Iowa Department of Health and Human Services (Iowa HHS) has revised its Childhood Lead Poisoning Risk Questionnaire tool and Blood Lead Testing Guidelines. The CLAW is a statewide working group of pediatricians, nurses, public health professionals, housing officials, elected officials, and more that provide input and direction to Iowa HHS on policy and programs related to childhood lead issues.

In recent years Iowa HHS has seen a decline in the rate of testing children for lead, especially amongst children under three years in age. Only 68% of one-year olds and 38% of two-year olds were tested for lead in 2019, below the 75% testing goal established by Iowa HHS for children one and two-years in age. Medicaid requires a blood lead test for all Medicaid-enrolled and eligible children one and two-years in age, while the Center for Disease Control & Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend testing for all children at 12 months and 24 months. Updates were made by the CLAW to help increase testing rates for children under 3 years in age, especially children in high-risk areas due to age of housing and other risk factors associated with lead exposures in Iowa.

Who should use the updated screening tool and follow blood lead testing guidelines?

Iowa HHS recommends all medical providers, pediatricians, and public health professionals conducting blood lead screening and testing on children under 6 years in age begin using the updated screening tool and implementing the new blood lead testing guidelines within their practices. A YouTube video was produced to explain the updates and provide guidance on using the following screening questionnaire and blood lead testing guidelines.

New Blood Lead Testing Guidelines and Screening Tool

Screening Tool and Testing Guidelines - Explanation, Purpose and Use

Screening Tool Implementation and Use Guidelines Video

CDC Blood Lead Reference Value Lowered to 3.5 µg/dL

The Center for Disease Control and Prevention (CDC) now use a reference level of 3.5 micrograms per deciliter (µg/dL) to identify children with blood lead levels that are much higher than most children’s levels. This new level is based on the U.S. population of children ages 1-5 years who are in the highest 2.5% of children when tested for lead in their blood as part of the 2015-2016 and 2017-2018 National Health and Nutrition Examination Survey (NHANES*). CDC will assess the reference value every four years using the two most recent NHANES surveys. The reference level may change over time. The reference level should not be confused with action levels for case management of services provided under local CLPPP contracts or by the Iowa HHS Lead Program. *NHANES is a population-based survey to assess the health and nutritional status of adults and children in the United States and determine the prevalence of major diseases and risk factors for diseases. Visit the Iowa HHS Adult Blood Lead webpage for information about adult blood lead reference levels.

Mandatory Blood Lead Testing in Iowa

In Iowa, legislation requires all children entering kindergarten have at least one blood lead level test. Iowa House File 158 was passed in 2007, amended in 2008 and became effective July 1, 2008. This is referred to as “Mandatory Blood Lead Testing.” Additional information regarding protocols for schools and Iowa HHS to follow for the mandatory blood lead testing can be found in the Resources section.

For more information on lead poisoning contact us at 1-800-972-2026 or online at Contact Us.