Healthcare Providers

Why Assess and Screen (test)?

• Low levels of lead exposure have lasting neurodevelopmental effects
• Screening may help prevent further exposure
• Early lead exposure can have long term health consequences: cardiovascular, cerebrovascular, endocrine, renal

Standard of Care on Screening for Childhood Lead Poisoning

State regulations impose specific responsibilities on doctors, nurse practitioners, and physician assistants doing periodic health care assessments on children between the ages of 6 months and 6 years. This is a brief summary of health care providers' responsibilities. These regulations apply to all physicians, nurse practitioners, and physician assistants, not just Medi-Cal or Child Health and Disability Prevention (CHDP) providers.

Anticipatory Guidance: At each periodic assessment 6 months-6 years

Health care providers who perform periodic health assessments for children are required to inform parents and guardians about:

• Risks and effects of childhood lead exposure
• Requirement for testing children in Medi-Cal
• Requirement for testing children not in Medi-Cal who are at high risk of lead exposure

Screen: At 12 and 24 months of age

For children in publicly supported programs (Medi-Cal, WIC, and CHDP):

• Blood lead test all children in publicly supported programs at both 12 months and 24 months of age

Assess: At 12 and 24 months of age

For children not in publicly supported programs:

• Ask: "Does your child live in, or spend a lot of time in, a place built before 1978 that has peeling or chipped paint or that has been recently remodeled?" at both 12 months and 24 months of age.
• Blood lead test if the answer is "yes" or "don’t know."

Missed Mandates: Catch-Up Required if Either Mandate is Missed

For children in publicly supported programs:

• If blood lead test at 12 months is missed, catch-up testing is mandated between 12 and 24 months.
• If blood lead test at 24 months is missed, catch-up testing is mandated between 24 and 72 months.

For children not in publicly supported programs:

• If assessment at 12 months is missed, an assessment (followed by a blood lead test, if found to be at risk) is mandated between 12 and 24 months.
• If assessment at 24 months is missed, an assessment (followed by a blood lead test, if found to be at risk) is mandated between 24 and 72 months.

Other Indications for Blood Lead Test

Not in regulations, but testing should also be considered:

• Suspected lead exposure (possible sources of lead)
• Parental request
• Recent immigrant from country with high levels of environmental lead
• Change in circumstance has put child at risk of lead exposure

Educational Materials for your Clinic

Our program can send you free educational materials on childhood lead poisoning for parents and healthcare staff. See and order them web site

Learn about CDC’s updated blood lead reference value, CDPH’s response, and recommendations for California health care providers.