Testing Children for Lead

Group of children playing in the snowChildren are at risk for lead poisoning when they are exposed to lead hazards. Children who are lead poisoned typically do not look or act sick. Therefore, the only way to know if a child is lead poisoned is to have a blood lead test.

Children from low income families are at greater risk for lead poisoning due to limited housing options. Wisconsin is working with primary care providers to improve blood lead testing, which most likely will identify more children who are lead poisoned.

 

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Wisconsin blood lead
testing recommendations

The Wisconsin Blood Lead Screening Recommendations (PDF) were developed based on input from a broad-based advisory committee. These guidelines recommend targeted screening of children who are at greatest risk for lead poisoning in all parts of the state other than the cities of Milwaukee and Racine, where universal testing is recommended.

Children living in the cities of Milwaukee and Racine

The Wisconsin Blood Lead Screening Recommendations include universal testing of all children living in the cities of Milwaukee and Racine. Because the high proportion of old housing in these communities creates a much higher risk of lead poisoning, each child should have a blood lead test three times before the age of 3 years: at around 12 months, 18 months, and 24 months. Children aged 3 through 5 years should be tested annually if they meet one or more of the following risk criteria; they:

  • Live in a house built before 1950.
  • Live in a house built before 1978 with recent or ongoing renovations.
  • Have a sibling or playmate with lead poisoning.
  • Are enrolled in Medicaid or the Women, Infants and Children Nutrition Program (WIC) or are uninsured.
  • Have no record of a prior test.
Children living outside the cities of Milwaukee and Racine

When seeing children from areas outside the cities of Milwaukee and Racine, health care providers are encouraged to use the Four Easy Questions below to determine whether a child is at risk for lead poisoning and needs to be tested at around 12 months and 24 months of age or between the ages of 36 and 72 months if there is no record of a previous test.

The Four Easy Questions are:

  1. Does the child live in or visit a house built before 1950 (including child care facilities and homes of friends or relatives)?
  2. Does the child live in or visit a house or building built before 1978 with recent or ongoing renovations (including child care facilities and homes of friends or relatives)?
  3. Does the child have a sibling or playmate with lead poisoning?
  4. Is the child enrolled in Medicaid or WIC?

To see data on the annual numbers of Wisconsin children tested by age, go to the Data and Data Analysis page.

Other reliable sources of information on blood lead testing and follow-up

Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention (PDF)

Managing Elevated Blood Lead Levels Among Young Children

Developmental Surveillance and Screening of Infants and Young Children (PDF)

Information for parents on blood lead testing

Blood Lead Levels in Children: What Do Parents Need to Know to Protect Their Children? (PDF)

Parents: Look Out for Lead, P-44535A (PDF)

What You Should Know about Your Child's Blood Lead Results (PDF)

Coping with Your Child's Diagnosis (PDF)

Places where children are tested for lead

Wisconsin local health departments

Wisconsin Women, Infants, and Children (WIC) Nutrition Program clinic locations

 

Children from low
income families

Children from low income families in Wisconsin are at greater risk for lead poisoning, largely because they have limited options for selecting housing. Often the homes they can afford are run down or poorly maintained. A child who receives either Medicaid health care benefits or vouchers from the Supplemental Food Program in the Women, Infants, and Children (WIC) Program is considered low income.

Children enrolled in Medicaid are required to receive blood lead testing as part of its Early and Periodic, Diagnostic and Treatment (EPSDT, also known as HealthCheck) services. More specifically, "all children enrolled in Medicaid should receive a screening blood lead test at 12 months and 24 months of age ... Children over the age of 24 months, up to 72 months of age, for whom no record of a previous screening blood lead test exists, should also receive a screening blood lead test." (Letter to State Medicaid Directors on Lead Screening from the Department of Health and Human Services, Healthcare Care Financing Administration, 1999).

Testing among Medicaid-enrolled children

The Wisconsin Medicaid Program collaborates with the Wisconsin Childhood Lead Poisoning Prevention Program in linking program data to determine blood lead testing and lead poisoning among Medicaid-enrolled children. The data linkage has demonstrated that, despite the federal testing mandate, many Wisconsin children enrolled in Medicaid are not tested at the appropriate ages (see table).

In 2016, only 60% of 1-year-olds, 48% of 2-year-olds, and 14% of children aged 3 to 5 not previously tested, were tested. Only 32% of Medicaid-enrolled children received the required testing at both 1 and 2 years of age.

Number of Wisconsin Medicaid children under age 6, tested for lead, by age, 2016
1 Year Olds

Total enrolled: 36,065
Total Tested: 21,608
Percent tested: 60%

2 Year Olds

Total enrolled: 33,902
Total Tested: 16,116
Percent tested: 48%

3-5 Year Olds, not previously tested

Total enrolled: 21,962
Total Tested: 3,172
Percent tested: 14%

 
Wisconsin Medicaid-enrolled children more likely to be lead poisoned

Annual Wisconsin data routinely show that Medicaid-enrolled children in Wisconsin are three times more likely to be lead poisoned than non-Medicaid-enrolled children. If all children on Medicaid had been age-appropriately tested during 2016, it is likely that additional children would have been identified as lead poisoned and could have received the interventions they needed.

Improving blood lead
testing of children

Improving blood lead testing of Wisconsin children

Wisconsin has implemented strategies at the state and local level to improve the blood lead testing of young children. Local public health staff have conducted outreach directly to physicians and clinics. If the locale has a lead task force, they may include clinical nurses or physicians on their committee. Local public health staff give presentations on the importance of blood lead testing to the public, to their local board of health, to clinicians, and to parents. At the state level, we have implemented the Wisconsin Blood Lead Registry.

Wisconsin Blood Lead Registry

The Wisconsin Blood Lead Registry (the Registry) is a web-based tool that allows a primary care provider or other health care professional to check a child’s blood lead testing history online anytime. The Registry is linked to the Wisconsin Immunization Registry (WIR) and is updated each week by the Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP) with new blood lead test results. This includes blood lead tests done at all locations, such as Women, Infants, and Children (WIC) sites, Head Start programs, and physicians’ offices. The Registry can help health care staff easily identify children who have not yet been tested or are due for another test.

To get access to the Registry, have the person designated to be your organization’s Registry site administrator complete the two forms listed below. Fill out one user agreement form for each person who wants access to the Registry. The forms can be sent electronically to the WCLPPP email address or fax all forms to 608-267-0402.

For more information about the Registry, please contact Pam Campbell, 608-267-3901.

Last Revised: September 20, 2019