Federal Medicaid Testing Requirement
Federal regulations require that all children enrolled in Medicaid receive a blood lead test at 12 and 24 months of age, or at 24 to 72 months of age if no record of a previous test exists. The Department of Health (DOH) recommends screening all children not covered by Medicaid at 12 and 24 months of age using this clinical algorithm (PDF).
Who to Test for Lead Poisoning
Healthcare providers should assess all children for risk of lead poisoning at 12 and 24 months of age. The Department of Health recommends performing a blood lead test on children with the following risk factors:
- Lives in or regularly visits any house built before 1950.*
- Lives in or regularly visits any house built before 1978 with recent or ongoing renovations or remodeling.
- From a low income family; income
- Known to have a sibling or frequent playmate with an elevated blood lead level.
- Is a recent immigrant, refugee, foreign adoptee, or child in foster care.
- Has a parent or principal caregiver who works professionally or recreationally with lead. (Examples: remodeling and demolition; painting; works in or visits gun ranges; mining; battery recycling; makes lead fishing weights or shotgun pellets; hobbies involving stained glass, pottery, soldering, or welding).
- Uses traditional, folk, or ethnic remedies or cosmetics. (Examples: Greta, Azarcon, Ghasard, Ba-baw-san, Sindoor and Kohl).
*Screening may not be indicated if the home has previously undergone lead abatement or tested negative for lead after remodeling.
Healthcare providers should consider testing additional children per clinical judgment, such as:
- Children whose parents have concerns or request testing (including older children that have risk of exposure).
- Children living within a kilometer of an airport or lead emitting industry, or on former orchard land.
- Children with pica behavior.
- Children with neurodevelopmental disabilities or conditions such as autism, ADHD, and learning delays.
Other consumer products found to have lead risk are informally imported foods and spices. Some candies imported from Mexico have been found to contain lead. Certain ingredients used in the candies, such as chili powder and tamarindo, are found to be the most common source of exposure. Lead has also been found in the ink of some imported candy wrappers as well as in nonregulated imported spices such as turmeric.
For complete lead screening recommendations for children in Washington state see, Clinical Algorithm for Targeted Childhood Lead Testing (PDF).
Lead Exposure Risk Mapping Tool
Healthcare providers are encouraged to use the Department of Health Lead Exposure Risk Index to better understand which areas in their community are at higher risk for lead exposure based on age of housing.
Medical Management of Children with Elevated Blood Lead Levels
For guidance on medical management, see the University of Washington's Pediatric Environmental Health Specialty Unit fact sheet: Medical Management of Childhood Lead Exposure (PDF).
In 2015, the Washington State Department of Health convened an expert panel to review and modify the Department's Childhood Blood Lead Screening Guidelines. See Recommendations on a Targeted Approach to Blood Lead Screening in Children (PDF).
Notice: The signed state standing order is no longer valid for use and has been removed from this page. We have replaced them with unsigned standing orders, for use as templates. Local Health Officers or other appropriate medical personnel may issue blood lead testing standing orders for the jurisdictions or organizations for which they are responsible.