Why is it a problem when communities are not regularly testing all children for elevated blood lead levels?

In most states around the country, regular blood-lead testing for toddlers–the age when children are most susceptible to lead poisoning because their brains are developing quickly, they are mobile enough to crawl or walk, and they tend to put everything in their mouths–is not mandatory. New York state requires mandatory blood lead testing twice before age 36 months.  New York state’s most recent data show that 63% percent of New York children born in 2013 were screened twice by age 36 months. Even mandatory blood lead testing requirements do not guarantee compliance.  In Louisiana, which also has mandatory testing, only 21% of children actually have their blood lead levels tested.

Most kids with elevated blood lead levels do not immediately show signs of lead poisoning.   This means that without regular testing, we cannot identify kids that have been exposed to lead until health or behavior problems arise later in life. Low levels of blood lead testing for children is particularly dangerous when communities only address lead hazards after a child has tested positive for lead poisoning. It is important that all young children receive regular blood lead testing so that communities may identify and remove lead hazards in a child’s environment. 

In addition to addressing threats from peeling and chipping paint and lead dust through primary prevention strategies such as a Proactive Rental Inspection program or a Renovation, Repair, and Painting program, communities should also be aware of other potential sources of lead exposure beyond paint.  These may include: 

  • the drinking water at home, school, or daycare, 
  • the paint at daycare;
  • the soil in a place where the children regularly play;
  • Traditional medicines, cosmetics; and
  • Peeling lead paint on playground equipment.

Also, without regular blood lead testing of all toddlers, it will be difficult for communities to fully understand the success or failures of their lead poisoning prevention programs. With comprehensive lead testing, communities can better understand how its programs may be lowering the incidence of lead poisoning at lower blood lead levels.


What’s the solution?

Mandatory blood lead testing is the first step in better understanding the scope of your community’s lead poisoning problem.  Many states that require blood lead testing for children require two tests during a child’s toddler years, the time when children are most likely to be mobile and putting things (like paint chips) in their mouth or chewing on windowsills or other paint-covered areas.

Best practices for mandatory blood lead testing include:

  • Require children to be tested at least twice during toddler years when children are most likely to put things in their mouth or chew on windowsills;
  • Define “elevated blood lead level” as the CDC reference level;
  • If a child is found to have a blood lead level at or above the CDC reference level, the local health authority must take action to identify and remove any lead hazards in the child’s environment.
  • Any child with an elevated blood lead level should be offered early intervention educational and behavioral support.  This could be done by changing the state’s definition of conditions that qualify for Early Intervention under part C of the IDEA include children with elevated blood lead levels, regardless of whether they are showing developmental delays.   Illinois has adopted early intervention for all lead-poisoned kids.