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Getting Started: Public Health Nurses New to Childhood Lead Poisoning Prevention

This page is for public health nurses (PHNs) and local health department staff new to childhood lead poisoning case management. It explains what public health nurses do, breaks down how most cases unfold, and provides links to important forms and reference documents.

For the full clinical detail behind everything on this page, see Lead-Safe Wisconsin: Health Care Guidance for Pediatric and Perinatal Patients.

Doctor holding a lead poisoning sign

The public health nurse's role

When a child's blood lead test comes back at or above the CDC's reference value of 3.5 μg/dL, a jurisdiction's PHN becomes the main point of contact for that child's family. The PHN's job is to check on the child's health and development, build a plan of care with the family and provider, connect the child to services, and stay involved until the case is ready to close. The PHN does not have to do all of this work alone, but they do need to make sure it all happens.

Before the first case: how to get set up

Here are some quick steps public health nurses new to childhood lead poisoning case response can follow to get set up:

How a case gets assigned

Once a child has received a blood-lead test, several things happen:

  1. A lab reports the blood lead test result to DHS following the timeline in the table below.
  2. DHS/CLPPP makes sure that the result is uploaded into HHLPSS.
  3. If the blood lead level is at or above 3.5μg/dL, a new clinical case opens automatically in HHLPSS (as long as the child doesn't already have an open case).
    1. A new environmental investigation will also automatically open in HHLPSS if:
      1. A venous sample is returned at or above 3.5 μg/dL.
      2. The property doesn't already have an open investigation.

Required response times scale quickly as a child's blood lead level result increases. See the full action table by:

Required lab reporting timeline

Please note: The reporting countdown starts at the time that the blood is analyzed at the lab, not when the blood is first drawn.

Child's blood lead level (μg/dL)The lab must report the result within...
< 5 μg/dLTen days.
5 - 44 μg/dL48 hours.
≥ 45 μg/dL24 hours.

The home visit

A home visit is the best way to get a full picture of a child's situation, and it is usually the PHN's first real contact with the family. Nurses may choose to use the EBLL Nursing Home Visit Task List (PDF) for support during this process. This task list breaks down the home visit into three steps:

It's important to get a comprehensive health history. During the visit, PHNs should gather the child's:

  • Date of birth.
  • Parent/guardian's contact information, including a secondary guardian if there is one.
  • Home address (and year built, if possible).
    • Also gather information on any secondary locations where the child might spend a significant amount of time.
  • Recent past living history and/or travel history.
  • Medicaid eligibility.
  • Medical referrals or support services already in place.

Lead poisoning can lead to life-long health struggles. It's important to monitor the child's health. Nurses should check:

  • Health status, including health history, a limited physical check, and a review of existing blood lead results in HHLPSS or WBLR.
  • Development and behavior. A screening tool such as ASQ-3 or ASQ:SE-2 can be used to screen for developmental delays.
    • Additionally, any child with a BLL at or above 10 ug/dL can be referred to the Birth to Three Program, even without a confirmed developmental delay.
  • Nutrition. Nutrition plays a role in how much lead is absorbed into a child's body. If possible, nurses should evaluate the child's current nutritional intake.
  • Other risk factors. PHNs can look for:
    • Pica or hand-to-mouth habits,
    • Imported cosmetics or home remedies.
    • A household member with a lead-related job or hobby.
    • Chipping or peeling paint.
    • Vinyl mini-blinds.

Families often know very little about lead exposure. PHNs can share information on:

All of CLPPP's educational materials on lead and lead exposure can be found in this educational materials list. Most handouts are available in English, Spanish, and Hmong.

Prepare the family for what's next, including:

  • The follow-up testing schedule.
  • The importance of testing any other siblings under age 6.
  • What to expect during the environmental investigation, if needed.

Build a plan of care with the family, including:

After the home visit

Once a home visit has been completed, there are several steps to take before a case is closed.

  1. Complete the Nursing Case Management Report, F-44771A (PDF) and upload it to HHLPSS. All information on this form must be charted in HHLPSS case events.
    1. For charting in HHLPSS, PHNs may use the Elevated blood lead level - Event types table.
    2. View HHLPSS Job Aids and FAQs for help with charting.
  2. Coordinate care with everyone involved:
    1. Share updates with the child's primary care provider.
    2. Stay in touch with the lead investigator and/or risk assessor handling the environmental investigation.
      1. For complex cases, consider a case conference with the risk assessor, WIC nutritionist, and others involved.
  3. Revisit the plan of care for new results and information, and keep the family in the loop. This process often takes a long time, and families rely on ongoing support.

Closing the case

A case must remain open until certain criteria are met. We listed these criteria below and in Table B of the Childhood Blood Lead Level Case Management Guidelines, P-03474 (PDF).

Once a case is ready to be closed, the PHN should complete the Nursing Case Closure Report, F-44771B (PDF) and upload it to the child's record in HHLPSS.

Main criteria for case closure

Type of caseWhen a case may be closed
Clinical case meets EBLL definition
  • Child has 2 consecutive BLLs less than 15 µg/dL at least 6 months apart.
  • Child is living in a lead-safe environment. Including:
    • An environment where lead hazard remediation work was completed and passed clearance.
    • An environment location where the source of lead was not lead-based paint and the child is no longer being exposed.
    • An environment location where no hazards were identified.
  • The case meets LHD policy and procedure closure criteria (if applicable).
Clinical case does not meet EBLL definition
  • Reasons vary. Follow LHD policy and procedures.

See the Lead-Safe Wisconsin: Health Care Guidance for Pediatric and Perinatal Patients webpage for the full definition of an Elevated Blood Lead Level (EBLL).

Other reasons for closure

  • Unable to locate child or family.
  • Family refuses further investigation.

Note: for children who change jurisdictions, move to another state, or do not meet any of the criteria above, contact the Childhood Lead Poisoning Prevention Program at DHSLeadPoisoningPrevention@dhs.wisconsin.gov.

Resources for public health nurses

The following documents are required to be completed when a nurse does a home visit:

The following documents are not required to be completed during case management, but may be used to support the work of the PHN:

The following documents can be shared with families:

For more information, PHNs can view the following:

Glossary

 
Last revised July 17, 2026