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PEHSU Factsheet: Recommendations on Management of Childhood Lead Exposure > Lead Screening & Testing

Lead Screening & Testing

posted on Sep 21, 2021
  • Bright Futures Guidelines recommend that all children should be screened—at well-child exams and as appropriate—with a questionnaire to assess for lead hazards and possible exposures. A positive screen informs the risk for lead hazards in the home and an opportunity for primary prevention. Those who are found to have lead hazards in their environment should receive a blood lead test.
  • Children should have blood lead testing at 12 and 24 months. Screening with a questionnaire should not take the place of testing (called “screening by blood test” by CDC and state statutes) of children at 12 and 24 months who are on Medicaid or in high-risk areas requiring universal blood tests as defined by state health departments. Lead testing can be performed with a capillary specimen obtained by a finger prick with blood blotted onto a testing paper. Testing in this manner requires that the skin surface be carefully cleaned. Elevated capillary BLL should have repeat testing by venipuncture to confirm the BLL.
  • In cases where the capillary specimen demonstrates an elevated BLL but the follow-up venipuncture does not, it is important to recognize that the child may live in a lead-contaminated environment that resulted in contamination of the fingertip. Work with the family to identify and eliminate potential sources of lead in these cases.
  • Where feasible, perform lead testing by venipuncture. Test all children in the same household if there is an elevated BLL.
  • Children at high risk for lead exposure include those who are low income, recent immigrants, international adoptees, children of immigrants, those with oral behaviors (or pica), those living in housing built before 1978 (when lead in residential paint was banned), but particularly in those built before 1950.