Childhood Lead Poisoning

Lead HarmLead is a soft, heavy, toxic metal.  It is found in many products we use every day—sometimes even in toys.  It can be found in house paint and in some dirt and dust.

Children under the age of 6 are especially at risk for lead poisoning because of their small size and developing brains. There is no safe blood lead level in children. Even low levels of lead in blood can have long-term, negative impacts on a child’s health. The good news is that lead poisoning is 100% preventable!


What is lead poisoning? 


Lead poisoning is caused by swallowing or breathing lead. Lead is poison when it gets into the body and causes many health issues, including:

  • -  Damage to the brain, kidneys, and nervous system
  • -  Slow growth and development
  • -  Difficulty learning
  • -  Damage to hearing and speech
  • -  Behavior problems

Lead can stay in the body for a long time and the damage caused by lead does not go away.


How will I know if my child has lead poisoning? 


Lead EnvironMost children who have lead poisoning do not look or act sick. The only way to know if your child has lead poisoning is to get a blood lead test. Ask your healthcare provider to test your child for lead. The Chester County Health Department recommends that all children get tested for lead at 12 and 24 months of age.

A blood lead test tells you how much lead is in your child’s body. The test measures lead levels as µg/dL, or micrograms per deciliter of blood. A small amount of lead can be found in most children’s blood because lead is in the environment; most children have lead levels less than 5 µg/dL. The first lead test is usually taken from the finger or toe; it is called a capillary sample. Sometimes blood from the arm, called a venous sample, is required to get a more exact measurement.  If your child has a lead level above 5 µg/dL from the capillary sample, it is very important to get a second test with a venous sample. Talk to your healthcare provider to determine what testing your child needs.


How do children get lead poisoning? 


Lead can be found throughout a child’s environment. The leading cause of lead poisoning is lead dust from lead-based paint used in home built before 1978. In Chester County, nearly 50% of homes were built before 1978 and may contain lead-based paint. Lead may also be found in water, toys, imported candies, and traditional home remedies. Adults may unknowingly bring lead into the home if they participate in certain jobs or hobbies that involve lead-based products.

Young children are exposed to lead through normal everyday activities such as crawling on the floor and putting their hands, toys, or other objects in their mouths.

For more information about sources of lead, visit: https://www.cdc.gov/nceh/lead/prevention/sources.htm


How do I protect my family from lead exposure? 


Lead PreventLead poisoning is 100% preventable! To prevent lead poisoning, first find out whether your child has been exposed to lead by having your healthcare provider perform a simple blood lead test. If the test is positive, you should have your home and items in your home tested for lead. If lead is found in your home, be sure to follow safe renovation practices and use a certified contractor.

Houses can be safely renovated by lead-safe certified contractors. The United States Environmental Protection Agency’s (EPA) Renovation, Repair and Painting Program describes steps contractors can take to safely renovate older homes. A certified risk assessor can help you decide whether abatement (eliminating lead hazards completely) is a better option for you.

The Chester County Health Department offers these childhood lead prevention services:

  • Free blood lead testing for uninsured kids under the age of six.
  • Case management services for children that have been identified as having an elevated blood lead level.
  • Referrals for testing and medical treatment.
  • Investigation of lead hazards in the homes of lead-poisoned children.
  • Education on reducing lead-poisoning exposure.

For more information about lead and lead poisoning prevention, you can reach the Health Department at 610-344-6225.


Recommendations for Healthcare Providers


The percentage of children who are being tested for lead exposure is low. To improve increase blood lead screening and testing rates, the Chester County Health Department (CCHD) provides the following recommendations for testing blood lead levels:

  1. Universal Blood Capillary Screening: Conduct blood capillary screening of all children ages 12 months and 24 months, and follow up with venous testing per the attached Blood Lead Level Guidance.
  2. Point-of-Care Screening: Healthcare providers are encouraged to implement point-of-care (POC) capillary screening, which resolves issues of compliance, drastically reduces barriers to testing, and provides an effective and efficient means of increasing blood lead level testing rates. If your practice is not already using POC capillary screening, please contact CCHD for various options.
  3. Blood Lead Screening Test at 12 Months and 24 Months: Major developmental changes occur between 9 months and 12 months of age, including increased mobility, which creates access to lead dust for consumption and inhalation. CCHD recommends testing at 12 months, and again at 24 months when lead levels peak in children. This will ensure children are tested during key development stages. This guideline is consistent with current American Academy of Pediatrics Bright Futures recommendation and national Medicaid guidelines.

  4. Note: All children enrolled in Medicaid/CHIP are required to receive blood lead screening tests at ages 12 months and 24 months. In addition, any child between 24 and 72 months with no record of a previous blood lead screening test must receive one. Completion of a risk assessment questionnaire does not meet the Medicaid requirement. The Medicaid requirement is met only when the two blood lead screening tests identified above (or a catch-up blood lead screening test) are conducted.

  5. Confirmatory Venous Testing Schedule after Elevated Capillary Test: Nearly one third of children with elevated capillary tests in Chester County do not receive a venous test to confirm the blood lead level. CCHD recommends conducting confirmatory venous testing as follows.

  6. Capillary Blood Lead Level

    Confirmatory Venous Test*

    3.5-19 µg/dL

    Within 1 Month

    20-44 µg/dL

    Within 1 Week

    45-69 µg/dL

    Within 24 Hours

    ≥ 70 µg/dL

    Immediately

    *CCHD recommendations are stricter than those of the Centers for Disease Control and Prevention.

  7. Compliance with Venous Test: While there is no substitute for the accuracy of a venous test, some patients are either unable or unwilling to get the test. In these situations, CCHD recommends conducting a capillary test at every opportunity to continue monitoring the blood lead level while educating the family about the need for a venous test. Note: CCHD does not begin case coordination and management without a confirmatory venous test.
  8. Electronic Health/Medical Record Reminders: Use reminders through EHR/EMR to ensure current recommendations and best practices are followed.


Guidance for Monitoring and Managing Blood Lead Levels


Healthcare providers can access detailed guidance for monitoring and managing blood lead levels to role of the involvement of the Health Department at Chester County Blood Lead Screening Guidance for Healthcare Providers.

Additional Resources

About Lead

For Healthcare Providers

For Homeowners and Landlords