Screening for Lead Toxicity

Lead is neurotoxic and affects both intellectual and behavioral function, even below the 10 ^/dL level established by the U.S. Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) (Canfield et al., 2003). Federal Medicaid law has required lead screening of young children eligible for Medicaid at ages 12 months and 24 months, and for children ages 36 to 72 months not previously tested. However, 1999-2004 NHANES data demonstrate that the percentage of children with blood lead levels of 10 ^/dL or higher had decreased to 3.4% for black and 1.2% for white children age 1 to 5 years. The USPSTF finds insufficient evidence to recommend for or against screening asymptomatic children 1 to 5 years old who are at increased risk. The CDC recommends targeted screening of specific groups of children, except in areas where universal screening is still recommended because of a prevalence of elevated lead levels. Specific state information can be obtained at http://www.cdc.gov/nceh/lead. Children considered at risk who require screening include (1) those suspected by a parent or health care provider to be at risk for exposure; (2) those with a sibling or frequent playmate with an elevated blood lead level; (3) those with a parent or caregiver who works professionally or recreationally with lead; (4) a household member uses traditional folk or ethnic remedies or cosmetics; or (5) family designated at increased risk for lead exposure by the health department because of local risk factors for lead exposure, such as residing in a high-risk zip code (Wengrovitz and Brown, 2009).

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