A 2008 Iowa law requires that each child entering kindergarten must have received at least one 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 Iowa Code states no kindergartner will be kept out of school if they did not have a blood lead test.

The following documents provide additional information and instruction for school officials.

Subscribe to the school-lead data match bulletin

Memorandum to Inform Parents About Lead Results

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.

Learn how mandatory blood lead testing is a matter of health equity for children:

Mandatory Blood Lead Testing and Health Equity_2021

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), 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.

Blood Lead Testing Guidelines and Screening Tool

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.

What to Do At Each Level

Under Iowa's Childhood Lead Poisoning Prevention Program children with blood lead levels less than 10 µg/dL are not required to have an “overall case manager” since no additional services are required beyond routine blood lead testing and providing information to the family. Venous blood lead level greater than or equal to 10 µg/dLare "Action Levels" that require a case manager who is responsible for ensuring the child receives all required services. Refer to the CLPPP service area map and list of contacts to find a local childhood lead program, or contact IDPH to determine the intervention services available in your county.

Iowa HHS provides guidelines for treatment and follow-up on childhood blood levels. 

State Hygienic Lab Blood Lead Analysis Guidelines & Testing Supplies

Iowa HHS recommends medical providers and clinicians continue testing children during the LeadCare test kit recall and supply shortage. The Iowa State Hygienic Lab (SHL) in Ankeny, Iowa has provided the following guidelines and testing supply forms for LeadCare II users.  Visit the CDC for additional information and updates on the LeadCare test kit recall.

Blood Lead Sample Submission Guidelines

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 Public Health Bureau of Environmental Health Services (IDPH EHS) 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

For more information on lead poisoning, contact the Iowa Childhood Lead Poisoning Prevention Program at 800-972-2026.