Identifying Children with Elevated Blood-Lead Levels

Children should not be used as lead detectors. For decades, nothing was done to prevent lead poisoning until a child was finally identified as lead poisoned. Thankfully, those days are almost over. Now, there is a greater focus on fixing up the nation's older housing stock before a child is poisoned. But there are some 38 million homes that still contain lead-based paint, with about 25% of all US housing containing actual lead exposure hazards. This means that it is inevitable that many more children will continue to get exposed to lead year after year, while work on housing proceeds and public education about how to prevent childhood lead poisoning continues as well.
The health effects of exposure to lead can be devastating, both to the child with an elevated blood lead level, and to that child's family. Those health effects get worse and worse if nothing is done to eliminate the lead exposure problem. Therefore, the first essential step is to identify each and every child with a lead problem. This can only be done by getting children tested for the presence of lead in their blood.
Since we know that the peak ages of risk for lead poisoning are between 12 months and 24 months of age, these are the most important points in time in which to get children tested. Ideally, all children under the age of six should be tested at least once. However, where resources are lacking or old housing is scarce, it may make more sense to promote a targeted approach to screening children for lead, focusing on children who are more likely to be exposed to lead, primarily because of where they live. In a 1997 guidance document, the US Centers for Disease Control and Prevention (CDC) set out its policy recommendations for a targeted screening approach. CDC's recommendations include a specific focus on screening children who live in neighborhoods where there is a substantial percentage of housing built prior to 1950.
Other CDC recommendations include screening children who live in or regularly visit a home built prior to 1978, where recent or ongoing renovations or remodeling are occurring. Also, children who are enrolled in Medicaid are known to be at greater than average risk for lead poisoning and must be screened.
There are two acceptable methods that can be used to screen children for exposure to lead. The preferred method is taking a venous blood sample. The alternative, called the fingerstick (or capillary) method, is generally considered to be a less accurate method, and it requires special care to insure against contaminated samples. For instance, the child's fingers must be carefully cleaned prior to taking a blood sample via the fingerstick method. Also, a fingerstick that reveals a blood-lead level above 10µg/dL must be followed by a venous sample to confirm the result