About Lead: Screening & Testing
The only way to know if a child has an elevated blood lead level is to do a blood lead test. Most children with lead poisoning do not show any immediate signs or symptoms.
If you are a parent or caregiver, talk to your doctor or contact your local health agency about getting your child’s blood lead level checked.
All children who reside in high-risk zip codes (which includes all of the City of Cleveland), as well as all children insured through Medicaid should have their blood tested at age 1 and 2 years, failing which they should have at least one blood lead test done prior to the age of 6.
Types of Blood Lead Testing
There are two types of blood tests that may be used.
- A finger-prick or heel-prick (capillary) test is usually the first step to determine if a child has lead in their blood. A small amount of blood is taken from the child’s finger or heel. This type of test can provide fast results. If this capillary level is high, a venous test is needed to confirm the level because it’s more accurate than a capillary test.
- A venous blood draw takes blood from the child’s vein. This type of test can take a few days to receive results and is often used to confirm blood lead levels seen in the first capillary test.
Understanding blood lead test results
There is no safe level of lead. The United States Center for Disease Control and Prevention (CDC) defines an elevated blood lead level as 3.5 micrograms of lead per deciliter of blood (µg/dL) or higher. 3.5ug/dL is the CDC reference level because, based on population-level data in the U.S., 97.5% of children under the age of 6 have a blood lead level below this level. This reference level is a level that prompts public health action.
A child’s blood lead level does not allow prediction of future symptoms.
Parents and caregivers should ask their doctor for the specific result of their child's last blood test, and should discuss with their doctor what the result means.
What happens after the test?
The family is typically notified by their primary care provider and may also receive a letter and phone call from the local health department. All blood lead tests for Ohio children are sent to the Ohio Department of Health (ODH).
If the number is lower than 3.5 ug/dL, the doctor will probably not recommend another lead test immediately or any other intervention.
If the number is 3.5 ug/dL or higher, testing may be repeated to confirm the child's blood lead level (if the initial test was performed by finger stick, a blood draw from a vein is required to confirm the level), and will be monitored over time.
Children 3 years old or younger with confirmed blood lead level of 5ug/dL or greater results in a default automatic referral to early intervention support services. Parent support is also available for children 3-5 years old. In Ohio, a child with blood lead level of 10ug/dL or greater triggers a public health lead investigation, to determine the source of the lead poisoning. ODH or the local health department will contact the parent/guardian to work with them to determine sources of lead exposure, including a risk assessment of the child’s home and the other places where the child spends significant time.
A child with blood lead levels of over 45ug/dL requires medical therapy, which is usually done in the hospital. Fortunately, this is now uncommon. For most children with elevated blood lead levels below 45ug/dL, there is no medication that is recommended – the most important treatment for elevated blood lead levels in children is to prevent further exposure.
How can my child and I get tested for lead poisoning?
Talk to your child’s primary care provider or contact the local health agency about getting a simple blood test to check for lead exposure. Your primary care provider can help decide whether a blood lead test is needed and can also recommend appropriate follow-up actions.Your medical insurance care manager can also help connect you to a primary care provider if you don’t have one.
Why should my child be tested for lead?
Lead is a toxic metal that can harm a child’s growth, behavior, and ability to learn. A blood lead level tells you how much lead is in your child’s blood. Most lead exposures occur when children lick, swallow, or breathe in dust from old lead paint.
What age should children be tested?
Children living in high risk zip codes (which includes all of the City of Cleveland), and children insured by Medicaid, should be tested at age 1 and 2 years, at least once before the age 6. This is required by law. In addition, children who do not meet these criteria should be tested if there is a clinical suspicion of lead exposure based on additional risk factors that can be assessed by a primary care provider. It is worth noting that children who have recently moved to the United States from abroad, especially refugees, should be tested.
Should adults and older children be tested for lead?
Children of all ages who are recent immigrants, refugees, or adoptees should be screened and tested at the earliest opportunity.
Your primary care provider can assess the need to test older children for lead poisoning based on specific environmental risk factors.
In Cleveland, the most common sources of lead exposure are related to paint and soil in older homes in children with hand to mouth behaviors. Elevated blood lead levels that continue into school-age are unusual and a relatively low blood lead level in a school-aged child does not exclude earlier lead poisoning. This helps to explain why a blood lead test in a school aged child who has difficulty with learning or behavior is not confirmatory – earlier lead poisoning may have been a factor contributing to the child’s current symptoms, even if the child does not currently have elevated lead levels. Hence the importance of timely preventive steps to get blood lead level tested at age 1 and 2 for the high risk population.
Adults should not routinely be tested for lead. There may be exceptions for some occupational or other risk factors for lead exposure, which can be discussed with your primary care provider.
Pregnant women should talk to their doctor about exposure to sources of lead. The most important step expectant parents can take to prevent lead poisoning is to find and safely remove lead hazards in their home.
What is my child’s primary care provider’s role?
Providers of primary care for children play a key role in the detection of lead poisoning as well as counseling to prevent lead exposure, connecting families to early intervention and supportive services and advocating for public health measures to address the problem. Your child’s primary care provider will order blood lead testing at 1 and 2 years of age (for all children residing in the city of Cleveland, other high risk zip codes, or insured by Medicaid), will coordinate follow up testing if needed, and assess risks to determine whether it is necessary to test at other times. Your primary care provider can also discuss ways to prevent lead exposure and to protect against the harms of lead exposure – for example, by providing optimal nutrition in your child’s diet and by providing sources of enrichment and support to help your child grow, develop, and learn.
What can I do to prepare my child for a lab test?
Having blood drawn can be scary, but parents and caregivers can help create a calm environment and build confidence for the child.
Empower yourself: Prior to the appointment, discuss your concerns and questions with their doctor. This can help you have peace of mind about the testing process.
Set realistic expectations: Do not pretend the experience will be painless. Instead of promising that a finger stick or blood draw won’t hurt, reassure your child that the process will be quick, the pain won’t last, and you’ll stay close.
Schedule wisely: Schedule the test at a time when your child is less likely to be tired or hungry. Eating beforehand will help decrease any chance of lightheadedness. The only exception to eating prior to the appointment is if test requires fasting—in which case, it can help to schedule first thing in the morning, and bring a snack for afterward.
Communicate beforehand: You know your child best. Talking about feelings or practicing calming techniques before the appointment can help. Make a game of staying still. Teach your child to inhale for three seconds and then exhale. Breathing exercises help your child feel in control of his or her body and helps make it easier to draw.
Offer a distraction: During a blood draw, help get your child’s mind—and eyes—off the procedure. If watching would be too stressful for them, distract him or her from staring at the needle.
Go with the flow: Drinking plenty of water is important for blood tests. Unless specially instructed by his or her doctor, encourage your child to drink water before the visit. Drinking water hydrates veins, which can help make a blood draw easier.
You can’t guarantee the experience will be totally pain free for your child. However, these tips will help increase your chance of an experience that will build confidence.
"Any amount of lead is toxic to your system."
Councilman Blaine A Griffin
Community Leader, Council President