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Who should be tested for lead poisoning in Washington State?
Risk Factor Questionnaire
Medical Management of Children with Elevated Blood Lead Levels
Expert Panel
Provider Resources

female doctor and young child

Who should be tested for lead poisoning in Washington State?

The Washington State Department of Health (DOH) continues to recommend that health care providers use their clinical judgment to decide which children to test for lead exposure.

While DOH does not recommend universal blood lead testing of all children, DOH does encourage the testing of children who may be at increased risk for lead poisoning, including those who:

live in or regularly visit a home or childcare facility built before 1960
live in or regularly visit a home built before 1978 that is being repainted or remodeled
have a brother, sister, or playmate with lead poisoning
live with an adult who is exposed to lead through work or hobbies
were recently adopted or have recently immigrated from another country
have licked, chewed or mouthed old painted surfaces, vinyl mini-blinds, or metal jewelry
may have been given traditional remedies such as Azarcon, Greta, Paylooah, or Kohl

A blood lead test should be performed whenever a parent, guardian, or health care provider suspects that a child is at risk for lead exposure or if a health care provider finds signs or symptoms consistent with lead overexposure (e.g., anemia, failure to thrive).

Even relatively low levels of blood lead (<10 µg/dl) have been shown to have subtle effects on the developing central nervous system in children resulting in IQ loss, learning difficulties, poor school performance, decreased attention span, and inappropriate behavior. As part of a diagnostic workup, health care providers may consider a blood lead test when a child presents with developmental or behavioral problems and no obvious cause.

Though DOH does not consider Medicaid-eligible children in Washington State to be at higher risk of lead poisoning than other children, it is important to note that the Federal government requires all children covered by Medicaid to have a blood lead test at 12 and 24 months of age. Head Starts and Early Head Starts in Washington also require enrolled children to have a blood lead test.

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Risk Factor Questionnaire

To date, no risk factor questionnaire has been shown to be effective in Washington State for identifying asymptomatic children for whom blood lead testing is appropriate. However, health care providers who would like to use a risk factor questionnaire in their practice may be interested in a basic personal risk questionnaire published by the Centers for Disease Control and Prevention in Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials. The questionnaire is located on page 62 of this guide.

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Medical Management of Children with Elevated Blood Lead Levels

Some aspects of medical management of elevated blood lead levels include retesting at periodic intervals. For more information, see the Centers for Disease Control and Prevention document, Managing Elevated Blood Lead Levels Among Young Children. The Pediatric Environmental Health Specialty Unit at the University of Washington is also available for consultation.

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Expert Panel

In June 2008, the Washington State Department of Health convened an expert panel to review and possibly modify the Department’s Childhood Blood Lead Screening Guidelines. View the full report Expert Panel Recommendations, July 2008.

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