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Provider Information
Screening Tool and Blood Lead Testing Recommendations
In partnership with the Iowa Institute of Public Health Research and Policy and the Childhood Lead Advisory Workgroup (CLAW), 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. 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.
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.
Blood Lead Testing Guidelines and Screening Tool
Guidelines for Treatment and Follow Up
Iowa HHS provides guidelines for treatment and follow-up on childhood blood levels.
Treatment for lead poisoning depends on how much lead is in the blood. The most important part of treatment is preventing more exposure to lead. A child with a small amount of lead can often reduce the level of lead in their bodies through proper nutrition, good housekeeping, and washing of the child's face and hands before eating and bedtime. The body will naturally get rid of the lead if these practices are put in place. Children with severe cases and extremely high lead levels in their blood may be hospitalized to get a medicine called a chelator. The chelator binds to the lead and makes it easier for the body to get rid of lead naturally.
Mandatory Reporting of Blood Lead Test Results
Iowa Administrative Code 641 Chapter 1 requires all blood lead test results be reported to the Iowa Department of Health and Human Services to monitor lead exposure in Iowa. This applies to all blood lead tests for any person living in Iowa, regardless of the person’s age or the test result. Patient address is essential to determine public health jurisdiction and must always be included in the report. Additional information required to be reported includes:
- Patient’s name
- Patient’s marital status
- Capillary or venous blood sample
- Patient’s address
- Patient’s telephone number
- Name and address of health care provider who performed the test
- Patient’s date of birth
- Name and address of laboratory
- Sex of patient
- Collection date
- Whether patient is pregnant
- Race and ethnicity of patient
- Analytical result
- Patient’s employer if occupationally exposed
How to Report
All analytical results greater than or equal to 20 micrograms per deciliter (µg/dL) in a child under the age of 6 years or a pregnant woman shall be reported to the department immediately by telephone at 1-800-972-2026 or fax (515-281-4529). All other analytical results shall be reported to the department at least weekly in one of the following formats:
- Electronic Lab Reporting - Electronic Lab Reporting (ELR) is required by Iowa Code.
- Point of Care (Magellan LeadCare II™) Users – Offices and clinics using the Magellan LeadCare II™ analyzer for onsite testing can use complimentary software available from the company to report. Software information is available at www.magellandx.com/leadcare-products/leadcare-ii/support/reporting-solutions/. Contact 800-972-2026 prior to submitting reports to Iowa HHS.
- Other Reporting Options - Laboratories unable to do electronic reporting at this time should contact 800-972-2026 to discuss other temporary options for reporting to Iowa HHS.
School Information
Mandatory Testing Requirement
A 2008 Iowa law requires that each child entering kindergarten must have received at least one blood lead test. The Iowa Code states no kindergartner will be kept out of school if they did not have a blood lead test.
Every fall, Iowa HHS requests a list of students enrolled in kindergarten from school officials and this list is compared with the Iowa HHS database of blood lead test results. Iowa HHS then provides the schools with the names of children who, according to the database, have not received a blood lead test. The schools then send a note to the parents of each child without a blood lead test result in the database.
The following documents provide additional information and instruction for school officials.
School Year Spreadsheet Instructions
The following memorandums can be used by school nurses to send to parents or guardians notifying them their child may not have received a blood lead test according to the health department's records.
For more information on mandatory blood lead testing, contact the Iowa Childhood Lead Poisoning Prevention Program at 800-972-2026.
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