There is no single, national protocol that tells medical providers in the U.S. whom to test for lead. The Centers for Disease Control and Prevention (CDC) recommends that each state create its own guidelines for providers. Therefore, testing guidelines vary by state. Additionally, these guidelines may be difficult to find and are also rarely enforced. As a result, decisions about which children get tested for lead are often made by individual practitioners without uniform guidance.
Additionally, a blood test showing lead in a child's body can result in different responses that vary by state. Although CDC provides a reference level as guidance, there is no single blood lead level at which action is triggered, nor are these actions consistent. Programs, policies, and funding to provide treatment for lead exposure and removal of lead hazards vary by state. Therefore, many children diagnosed with lead in their bodies do not receive meaningful assistance.
What's the difference between screening, testing, and risk assessments?
The terms lead screening and testing are often used interchangeably. They refer to the procedures where blood is withdrawn from the child and the sample is analyzed for lead.
Risk assessments are used to determine if a child should receive a lead test. The child's parents or guardian are asked questions to determine if there may be lead in the child's environment. Common questions include: Does your child live in a house built before 1978? Does your child drink or eat out of ceramic cookware? Does your child have a sibling or playmate that has been diagnosed with lead poisoning?
What are the national guidelines for children's lead testing?
The CDC recommends that decisions about lead testing be made at the state level based on local risk factors. Some states require all children be tested for lead exposure, but most states ask medical providers to conduct a risk assessment to determine whether a child should be tested for lead.
Children enrolled Medicaid are required to be tested at 12 and 24 months of age. If they are between 36 and 72 months of age and have not had a prior lead test, they are required to receive one.
What is the CDC reference level?
The reference level is the blood lead level at which the CDC recommends action be taken to remove sources of lead from a child's environment. The reference level is not a safety level. No amount of lead in the body is safe, and harm can occur at exposures beneath the reference level. However, services are generally not provided to families unless blood lead levels are much higher than the reference level.
The current reference level was determined by identifying the blood lead level at which 2.5% of children in the U.S. are estimated to be at or above, based on national survey data from NHANES. The current reference level (5 ug/dL) was updated in 2012.
Why might some medical providers test fewer children than others?
There are many reasons why lead testing practices vary among medical providers. These may include:
- Perception that lead is not a problem in their patient population
- Lack of awareness of state and local guidelines
- Limited enforcement of lead testing requirements
- Lack of penalties for failing to test children
Even when there are legal requirements for medical providers to test children for lead, compliance is limited. For example, in 2015, medical providers only tested 38% of the children on Medicaid who were required to be tested for lead. Most states lack the funding to enforce these requirements.