Lead is a potent neurotoxin that poses significant health risks, especially to young children and pregnant women, impairing brain development and causing long-term behavioral issues. Even low levels of lead exposure can negatively impact a child’s IQ and attention span, and at very high levels, it can lead to severe health problems such as seizures or death. Despite declines in blood lead levels due to regulations banning lead in gasoline, paint, and plumbing, lead remains a persistent hazard, primarily from older buildings with lead-based paint and outdated plumbing. Additional sources of lead include contaminated soil, water from old lead pipes, and certain imported goods. Efforts to manage and mitigate lead exposure continue, including monitoring air quality and addressing risks from various occupations and consumer products.
Allegheny County Universal Blood Lead Level Testing Requirements
ACHD regulations require that all children at approximately 9-12 months have their blood lead level tested. Children are tested again at approximately 24 months of age.
If for any reason a child has not been tested by 24 months, they should be tested as soon as possible after 24 months, but before the age of six or prior to entering kindergarten, which ever happens first.
Source: Allegheny County Health Department 2022 Lead Report.
CDC Requirements
Healthcare providers may use a capillary or venous sample for initial BLL screening. If capillary results are equal to or greater than CDC’s Blood Lead Reference Value (BLRV), providers should collect a venous sample.
If the patient’s BLL is ≥ 3.5 micrograms per deciliter, provide education about common sources of lead exposure and information on how to prevent further lead exposure.
Common sources of exposure include paint in homes built before 1978, contaminated soil, and contaminated drinking water. In addition to these sources of lead, there are several other sources that exist and can be harmful to children.
Adults can help reduce children’s lead exposure by frequently washing children’s hands, especially before meals and frequently wiping and cleaning children’s toys.
For children living in or visiting homes or structures built before 1978, adults can reduce lead exposure from lead-based paint by:
Regularly wet-wiping windows and windowsills and wet-mopping floors.
Avoiding repairs and construction projects that may create lead-based paint dust.
Covering chipping or peeling paint to keep lead from spreading to surrounding areas.
Using approved methods for removing lead hazards from the home and using contractors certified by the Environmental Protection Agency (EPA) when repairs or renovations are needed. Visit EPA’s webpage to locate a certified contractor.
Obtaining a confirmatory venous sample for blood lead testing per the schedule:
CDC recommends that healthcare providers use a venous draw for confirmatory BLL screening. If the initial screening test used a venous sample, the patient does not need another venous draw.
Test Results and Next Steps
BLL is < 3.5 micrograms per deciliter
Provide education about common sources of lead exposure and information on how to further prevent exposure.
During well-child visits, check development to make sure age-appropriate milestones are being met. Discuss diet and nutrition with a focus on iron and calcium intake.
Conduct follow-up blood lead testing at recommended intervals based on the child’s age.
Centers for Medicare and Medicaid Services requires all children enrolled in Medicaid to get tested for lead at 12 and 24 months, or 24–72 months if they have never been screened.
For children not enrolled in Medicaid, CDC recommends focusing screening efforts on high-risk neighborhoods and children. Identify risk for lead poisoning based on the age of housing and social and demographic risk factors.
Public health personnel and healthcare workers should use local data to develop screening plans that are responsive to local conditions. In the absence of such plans, CDC recommends universal blood lead testing.
BLL is 3.5-19 micrograms per deciliter
Follow the recommendations for BLL < 3.5 μg/dL.
Test results are reported in PA-NEDSS and accessed by the Allegheny County Health Department
For children under the age of six, ACHD will call the family and offer aFREE in-home Environmental Lead Investigation to identify the source.
Any child under three with a reference level of ≥ 3.5 µg/dL is automatically eligible and enrolled in developmental tracking and early intervention services with the Alliance for Infants and Toddlers.
Physicians should inform the family that they should expect a call from the ACHD and encourage them to utilize these services.
If families are hesitant to accept services from the county, but may be open to help from other sources, encourage them to contact Women for a Healthy Environment at 412-404-2872 or info@womenforahealthyenvironment.org
For children under three, you can also make a direct referral to early intervention services to the Alliance for Infants and Toddlers by calling 412-885-6000.
UPMC for You (Medicaid), UPMC for Kids (CHIP), and Highmark WholeCare members are eligible for a no-cost Environmental Lead Investigation to identify the sources of lead exposure in the home.
UMPC: Contact the UPMC Health Plan Special Needs Unit at 1-866-778-6073
Highmark: Contact the Care Navigator Team at 1-800-392-1147
Allegheny County Lead Safe Homes Program (ALSH) offers free lead-paint testing and removal by a lead-safe certified contractor.
The program is open to income-qualifying homeowners and renters in Allegheny County.
During well-child visits, check on development of age-appropriate milestones and discuss nutrition with a focus on iron and calcium intake.
Conduct follow-up blood lead testing at recommended intervals based on the child’s age:
BLL is 20-44 micrograms per deciliter
Follow the recommendations for BLL is 3.5–19 μg/dL.
Perform a complete history and physical exam, assessing the child for signs and symptoms related to lead exposure.
Arrange for or refer the family for an environmental investigation of the home and a lead hazard reduction program.
Consider performing an abdominal X-ray to check for lead-based paint chips and other radiopaque foreign bodies. This is important for young children who tend to swallow or eat non-food items. Children may also put their mouths on surfaces that could be covered with lead dust. Initiate bowel decontamination if indicated.
Contact a Pediatric Environmental Health Specialty Unit (PEHSU) or the Poison Control Center (1-800-222-1222) for guidance. PEHSUs provide information on protecting children and reproductive-age adults from environmental hazards. PEHSUs work with healthcare professionals, parents, schools, and community groups.
BLL is ≥ 45 micrograms per deciliter
Follow recommendations for BLL 20–44 μg/dL.
Perform a complete history and physical exam including a detailed neurological exam.
Perform an abdominal X-ray and, if needed, initiate bowel decontamination.
If the patient exhibits signs or symptoms of lead poisoning, including confusion, weakness, seizures, coma, nausea, vomiting, and abdominal pain, admit them to a hospital as soon as possible.
Consider admitting the patient to a hospital if one of these conditions exists:
The patient’s home is not lead-safe, and they are unable to find a lead-free living space.
The source of lead exposure has not been identified and the potential for further lead exposure is still possible.
The healthcare provider is consulting with a medical toxicologist or pediatrician with experience in treating lead poisoning to initiate gastrointestinal decontamination (removal of swallowed lead using laxatives) or chelation therapy (a treatment that uses a medication to remove lead from the body when BLLs are very high).
