Resources for Healthcare Providers

On October 28, 2021, the Centers for Disease Control and Prevention (CDC) updated its blood lead reference value (BLRV) from 5 µg/dL to 3.5 µg/dL in response to the Lead Exposure Prevention and Advisory Committee (LEPAC) recommendation made on May 14, 2021.  The BLRV is intended to identify children with higher levels of lead in their blood compared to most children, based on the 97.5th percentile of the blood lead level (BLL) distribution in U.S. children ages 1 to 5. This action by CDC is a reminder of how important it is for early blood lead testing, so parents can take steps to keep their children safe from the toxic and irreversible effects of lead exposure.”

Snohomish County Health Department will be following the recommendations of the CDC in their case management services with families who have children with EBLL’s at 3.5 µg/dl or higher. Washington state will be continuing to report EBLL at 5 µg/dL and higher until further notice.

The Centers for Medicare & Medicaid Services require blood lead tests for all children with Medicaid coverage at ages 12 months and 24 months. In addition, any child between ages 24 and 72 months with no record of a previous blood lead test must receive one.

In Washington State, healthcare providers should assess all children for risk of lead poisoning at 12 and 24 months of age.

Healthcare providers should consider testing additional children per clinical judgment, such as:

  • Children whose parents have concerns or request testing (including older children that have risk of exposure).
  • Siblings of children with elevated blood lead levels.
  • Children living within a kilometer of an airport or lead emitting industry, or on former orchard land.
  • Children with pica behavior.
  • Children with neurodevelopmental disabilities or conditions such as autism, ADHD, and learning delays.

Lead screening recommendation resources

The CDC provides recommendations on medical management of lead exposure and poisoning based on a patient’s lead levels. The link also discusses principles of lead exposures in children, information on lead screening, and principles of iron deficiency screening as well as additional resources.

Case Management

Blood lead levels are a reportable condition in Washington state. Under the state’s reporting law, all laboratories performing blood lead tests are required to report the results of those tests directly to the Washington State Department of Health. All elevated blood lead levels (3.5 µg/dL or higher in youths under age 15, and 10 µg/dL or higher in adults) must be reported within two days. All other test results must be reported within one month.