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).
Changes to DOH Recommendations for Health Care Providers
Washington State’s blood lead action level is now 3.5 micrograms per deciliter (µg/dL) to better protect children from the harms of lead and to prevent further exposure. There is no safe blood lead level, and even low levels of exposure can harm a child’s health and development.
DOH recommends health care providers begin blood lead confirmatory and follow-up testing starting at 3.5 µg/dL. See the Provider Quick Guide (PDF) and the State Health Officer Letter of Support (PDF) for more information. For additional context on the national blood lead reference value of 3.5 µg/dL, please see the reference list (PDF).
Who to Test for Lead Exposure
Health care providers should assess all children for risk of lead exposure 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 1978*
- Family eligible for income-based assistance programs (such as SNAP, WIC, TANF, etc.)
- 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; uses lead fishing weights or shotgun pellets; hobbies involving stained glass, pottery, soldering, or welding).
- Uses certain traditional remedies or cosmetics
- Family uses imported ceramic or aluminum cookware.
- Child consumes certain imported spices or candies.
*Testing may not be necessary if the home has previously undergone lead abatement or tested negative for lead after remodeling.
Additionally, health care providers should consider testing children per clinical judgement, including in instances where the child patient has any of the following:
- Parents request testing (including older children with exposure risk).
- Lives within a kilometer of an airport, lead-emitting industry, or on former orchard land.
- Pica behavior.
- 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.
Provider Quick Guide
The Provider Quick Guide (PDF) covers the basics of pediatric blood lead testing including exposure risk factors, recommended retesting schedule, reporting requirements, and medical management guidelines from PEHSU.
Medical Management of Children with Elevated Blood Lead Levels
For guidance on medical management, see the University of Washington's Management of Childhood Lead Exposure, PEHSU (PDF).
Medical Management of Pregnant and Breastfeeding People with Elevated Blood Lead Levels
Flyer - Pregnancy and Lead: Do I need a lead test? (PDF)
Management of Lead Exposure During Pregnancy: Guidance for Healthcare Providers (PDF)
Management of Lead Exposure during Breastfeeding: Guidance for Healthcare Providers (PDF)
Statewide Childhood Lead Screening, Testing, and Reporting Plan
To learn about the Childhood Lead Poisoning Prevention Program's strategy to promote blood lead testing in our state, see Washington State Child Lead Screening and Testing Plan, January 2024 (PDF).
Expert Panel
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).
Standing Order
Blood Lead Testing Standing Order (PDF) - The statewide standing order authorizes point-of-care blood lead testing and analysis.