For screening children:
The CDC released guidelines for testing children for lead in 1997 and guidelines for managing children found to have elevated blood lead levels in 2002. They recommend that each state develop a plan to detect children who may have been exposed to lead. The CDC and the AAP recommend that, at a minimum, screening be offered to:
- Every Medicaid-eligible child and those children whose families are part of an assistance program; these children should be screened at age 1 and again at 2 years of age.
- At risk children 3-6 years of age who have not been previously tested.
- Children who live in or regularly visit a house or apartment built before 1950, or before 1978 if the dwelling has been/or is undergoing renovation or remodeling.
- Children with a playmate or sibling who has or did have lead poisoning.
People should check with their local health department regarding lead screening guidelines specific to the risks in their area.
The CDC and AAP recommend that children of parents who work with lead be considered for screening, and that immigrant, refugee, and other foreign-born children be tested when they enter the United States.
Managing children with elevated blood levels:
Since fingerstick samples can be contaminated during collection of the specimen, an initial elevated result obtained by a fingerstick sample should be repeated with a venous test for confirmation, usually within a week to a month after the first test. Follow-up testing is then used to monitor the persistence of an elevated blood lead test and is recommended whenever a child’s blood lead level is higher than 10 micrograms per deciliter. Those with persistent lead levels above 15-19 micrograms per deciliter (remain elevated for 3 months or more) and those with initial tests greater than 20 micrograms per deciliter should have their home surroundings evaluated to determine the source of the lead exposure.
For screening adults:
Blood lead tests may be ordered to screen people in the workplace if lead contamination is a possibility. Family members also may be screened because lead can be carried home on clothing. This testing conforms to federal and state laws for occupational exposure.
There is not yet a national guideline for blood lead screening in adults as there is for children. The clinical cut-off values for elevated blood lead currently vary from state to state. According to the CDC's Adult Blood Lead Surveillance program (ABLES), a national health objective is to reduce all blood levels in adults to less than or equal to 25 micrograms per deciliter.
Adults who work in industries known for lead exposure, such as smelter facilities, lead plating, auto repair, and construction, should be screened for lead exposure. Adults who have hobbies that involve lead-based paints, ceramics, or gasoline also should be tested. For a list of hobbies that may expose someone to potentially high levels of lead, go to Lead Poisoning.
The Occupational Safety and Health Administration (OSHA) has developed rules for monitoring for lead in the workplace. OSHA requires that employee blood monitoring programs be triggered by the results found in an initial air monitoring program. If a worker has an initial blood lead test result of more than 40 micrograms per deciliter, for example, testing should be done every two months until two consecutives lead tests show a blood lead level below micrograms per deciliter. Higher levels call for closer monitoring.
For both children and adults, lead testing may be ordered when a person's symptoms suggest potential lead poisoning. These symptoms are non-specific and may include fatigue, changes in mood, nausea, prolonged stomach distress, headache, tremors, weight loss, peripheral neuropathy, anemia, reproductive failure, , memory loss, seizures, and coma. Many children have no symptoms at the time of the exposure, but potentially permanent damage can still be occurring. Testing for lead exposure should be considered in children presenting with growth failure, anemia, sleep problems, hearing loss, or speech, language or attention deficits.