Lead-Safe Wisconsin: Health Care Guidance for Pediatric and Perinatal Patients
Local health departments and clinicians work together to support lead poisoning case management. This page provides a breakdown of the State of Wisconsin's lead testing and case management guidelines for children and perinatal patients.
- For public health nursing guidance, visit: Getting Started: Public Health Nurses New to Childhood Lead Poisoning Prevention
- For more information on adult patients, visit: Adult Lead For Health Professionals
Lead testing for pediatric patients
Wisconsin recommends universal testing. Universal testing means that every child should be tested for lead. The state recommends:
- All children should receive a blood lead test at both age 1 and age 2.
- All children between ages 3 and 5 should receive a blood lead test if they have not yet been tested.
Lead can affect any child, and symptoms commonly do not appear until it is too late to prevent substantial health problems. Universal testing ensures that no child is missed.
To learn more about the state's stance on blood lead testing, visit Get Your Child Tested for Lead
State definitions for different blood lead levels
There is a difference between how the state of Wisconsin defines a lead-poisoned child and a child with an elevated blood lead level (EBLL). The difference is important, because it informs what health care responses are required.
The official definitions of lead poisoning and elevated blood lead level can be found under Wisconsin Stat. § 254.11 definitions.
In Wisconsin, a child is considered to have an elevated blood lead level (EBLL) if either of the following are true:
- One venous blood lead level is greater than or equal to 20 µg/dL.
- Two venous blood lead levels are greater than or equal to 15 µg/dL when drawn at lead 90 days apart.
An EBLL prompts public health actions like home visits, inspections, and nursing case management.
There is no safe level of lead in the blood. Even small amounts of lead can harm a child's development. However, both the CDC (Centers for Disease Control and Prevention) and the Wisconsin Department of Health Services (DHS) have set action levels to help identify and respond to children who are most at-risk for serious health impacts.
Wisconsin recognizes any blood lead level greater than or equal to 3.5 µg/dL as evidence of lead poisoning. This is based on the CDC's current reference value. At this level, clinicians should offer follow-up testing and educational support. Families should take steps to reduce further exposure.
Childhood lead poisoning clinical response guidance
The State of Wisconsin recommends different actions depending on a child's blood lead level. The following information can also be found in the Childhood Blood Lead Level Case Management Guidance, P-03474 (PDF).
| Blood lead levels | Clinical response |
|---|---|
| 0 - 3.4 µg/dL |
|
| 3.5 - 4.9 µg/dL |
|
| 5 - 45 µg/dL |
|
| ≥ 45 µg/dL |
|
The following case management activities can be done by the public health nurse or the primary care provider:
- Lead education
- Lead prevention information
- Developmental assessment
- Nutritional counseling
- Referrals for support as needed
- History and physical exam
Additional resources for medical providers
- Blood Lead Lab Reporting, F-00017
- Training: Childhood Lead Poisoning Prevention (CDC)
- Milwaukee County 2025 Childhood Lead Testing Policy and Practice: Assessment and Recommendations - Milwaukee Health Care Partnership
Lead testing and screening for perinatal patients
Lead can harm both pregnant person and baby. Lead in the blood during pregnancy has been associated with poor health outcomes, such as:
- Pre-eclampsia
- Miscarriage
- Gestational hypertension
- Low birth weights
- Impaired fetal neurodevelopment
Lead can cross the placental barrier, which can expose the developing fetal brain to lead.
During pregnancy: actions to take starting at the first prenatal visit
Early screening, testing, and action can prevent harm to both the pregnant person and the infant.
Use this Risk Factor Questionnaire (PDF) to screen a pregnant patient for their risk of lead exposure or lead poisoning. The Risk Factor Questionnaire allows providers to quickly determine if a patient is at risk for lead exposure of has a history of lead poisoning. Both scenarios can put a pregnant patient and their baby at risk.
If it is determined that a patient is at risk of lead exposure or lead poisoning, providers should:
- Order a venous blood lead test.
- Follow the guidance below.
- Work with the patient to identify and interrupt the source of lead exposure.
The state of Wisconsin considers an individual with a venous blood lead level (BLL) greater than or equal to (≥) 3.5 µg/dL to be lead poisoned. If a patient has an initial capillary blood lead test result of ≥ 3.5 µg/dL, they should receive a confirmatory venous test. This test confirms that the initial capillary blood lead test was accurate.
Subsequent follow-up tests help to monitor the patient. If blood lead levels go down, the source of lead exposure was potentially identified and eliminated or reduced.
The following blood lead testing recommendations are based on the guidance from the American College of Obstetricians & Gynecologists (ACOG): Lead Screening During Pregnancy and Lactation.
| Initial Maternal BLL | First follow-up test | Subsequent follow-up tests | Test at delivery |
|---|---|---|---|
| 3.5 - 14 µg/dL | Venous, within 1 month. | None needed, unless the first follow-up test places the patient into the next tier. | Maternal venous and/or cord blood. |
| 15 - 24 µg/dL | Venous, within 1 month. | Venous, every 2-3 months. | Maternal venous and/or cord blood. |
| 25 - 44 µg/dL | Venous, within 1 month. | Venous, monthly. | Maternal venous and/or cord blood. |
| ≥ 45 µg/dL | Venous, within 24 hours. Consult with an expert in lead poisoning and chelation. | Venous, at frequent intervals depending on clinical interventions and trend in blood lead levels. | Maternal venous and/or cord blood. Consult with a maternal fetal medicine specialist. |
For blood lead levels 3.5 - 14 µg/dL
- Administer Risk Factor Questionnaire to identify possible exposure sources.
- Provide patient education about reducing sources of lead exposure.
- Evaluate nutritional needs. See nutrition guidance below for guidance on diet and supplementation.
For blood lead levels ≥ 14 µg/dL
- Administer Risk Factor Questionnaire to identify possible exposure sources.
- Provide patient education about reducing sources of lead exposure.
- Evaluate nutritional needs. See nutrition guidance below for guidance on diet and supplementation
- Notify the infant's clinician that continued BLL monitoring is recommended.
After pregnancy: guidance for lactating patients
It is possible for babies to be exposed to lead through breast milk. Patient monitoring is vital in protecting the health of both the breastfeeding patient and baby.
If not completed during pregnancy, use the Risk Factor Questionnaire (PDF) to screen a lactating patient for their risk of lead poisoning or lead exposure.
If you identify that the patient is a risk of lead exposure or poisoning,
- Order a venous blood lead test.
- Provide patient education on preventing exposure to lead.
Breastfeeding gives babies optimal nutrition and protects them against common illnesses. While formula is a safe alternative, breastfeeding offers superior short-term health advantages. For this reason, breastfeeding is recommended for all patients except for those with extremely high blood lead levels.
The following breastfeeding recommendations are based on the guidance from the American College of Obstetricians & Gynecologists (ACOG): Lead Screening During Pregnancy and Lactation.
| Maternal blood lead level | Recommended action |
|---|---|
| < 40 µg/dL |
|
| ≥ 40 µg/dL |
|
More information for providers of perinatal patients
- Risk Factors and Pregnancy | Childhood Lead Poisoning Prevention | CDC
- Lead Screening During Pregnancy and Lactation | ACOG
- Lead and pregnancy: Know the risks | Poison Control
- Adult Lead Program (DHS)
Patient education information
| Title | Description | Language(s) |
|---|---|---|
| 3 ways to protect your child from lead poisoning, P-03557B | Three top tips to prevent lead poisoning and keep your child safer. | English, Spanish, Hmong |
| How to Talk with your Child's Doctor about Lead Testing, P-03557J | Doctor's appointments can be filled with lots of activity, questions, and information, but your health care team is there to help you. Learn how to talk to your doctor. | English, Spanish, Hmong |
| Sources of Lead Exposure, P-03605 | Understand common sources of lead exposure. | English, Spanish |
| Keeping You and Your Family Safe from Lead, P-02409 | Information about potential lead exposures and your work, hobbies, or pregnancy. | English, Spanish, Hmong |
| Lead in Drinking Water Fact Sheet, P-02602 | Understand how to protect yourself from lead in water. | English, Spanish, Hmong |
| Lead-Safe Homes Program: Making Homes Lead-Safe for Kids, P-03292 | The Lead-Safe Homes program works with eligible families to renovate their pre-1978 homes. | English |
| Know the facts: Protect your child from lead exposure (CDC) | This fact sheets provides information that can help you protect your child from lead exposure. | English, Spanish |
| Lead poisoning: 5 things you can do to lower your child's lead level (CDC) | If your child has a high blood lead level, there are things you can do at home to help. | English, Spanish |
| Fight Lead Poisoning with a Healthy Diet (EPA) | Brochure for parents explaining lead hazards and providing information on how a healthy diet can protect against lead's harmful effects. | English, Spanish |
| What You Should Know about Your Child's Blood Lead Test Result (NCHH) (PDF) | Understand your child's blood lead test result. | English |
| Keep Your Family Safe - Don't Bring Lead Home From Your Job, P-01737 | You can come into contact with lead through your job or hobbies. Don't bring it home! | English, Spanish, Hmong |
| The Lead-Safe Certified Guide to Renovate Right (EPA) | General information about legal requirements for safe lead practices for homeowners, tenants, child care providers, and parents during renovation activities. | English, Spanish |
| Lead Bullets and Venison: What every hunting family should know (DNR, DHS) | Protect yourself and your family from the hazards associated with lead bullets. | English |
| Are You Pregnant? Prevent Lead Poisoning: Start Now (CDC) | Lead can pass from mother to baby. The good news is that lead poisoning is preventable. | English, Spanish |
A healthy diet can help reduce how much lead the body absorbs. Certain nutrients make it harder for lead to stay in the body.
During pregnancy and lactation, lead from prior exposures can be mobilized from the bones due to increased bone turnover. Adequate calcium intake can help reduce lead from remobilizing into the blood steam.
Patients, or their guardians, should be educated on the importance of a diet that includes:
Iron, calcium, and zinc
Iron, calcium, and zinc compete with lead for absorption. Eating foods rich in these nutrients can result in less lead being absorbed by the body.
Iron-rich foods
- Meat
- Beans
- Iron-fortified whole grains and cereals
- Eggs
- Fish
Calcium-rich foods
- Milk
- Yogurt
- Cheese
- Calcium-fortified foods and drinks
- Tofu
- Cooked spinach and broccoli
- Legumes
Zinc-rich foods
- Red meat
- Beans
- Fortified cereals
- Dairy products
- Legumes
Note: People with an iron deficiency absorb two to three times more lead than people with enough iron in their blood. Iron and lead interact and compete in heme synthesis. Even slight decreases in hematocrit can lead to increased lead absorption.
Find more information on iron deficiency in the CDC recommendations to prevent and control iron deficiency in the United States.
Vitamins C, D, and E
Vitamin C helps the body absorb iron, which offers increased protection from lead. Vitamin D and E can also help to support the body's ability to handle lead exposure.
Vitamin C-rich foods
- Citrus fruits
- Tomatoes
- Bell peppers
- Kiwi
- Strawberries
- Melons
- Mango
- Cauliflower
Vitamin D-rich foods
- Fish cheese
- Mushrooms
- Egg yolks
- Fortified:
- Milks
- Cereals
- Juices
- Yogurts
Vitamin E-rich foods
- Nuts and seeds
- Seafood
- Oils
- Avocado
- Apricot
- Broccoli
- Asparagus
- Leafy greens
Supplementation
If needed, nutritional supplementation can be considered, particularly for iron and calcium.
The following calcium and iron supplementation recommendations are based on the guidance from the American College of Obstetricians & Gynecologists (ACOG): Lead Screening During Pregnancy and Lactation.
Patients should talk to their providers before taking supplements.
Recommended dosages for adults:
| Supplement | Recommended dosage | Recommended dose size* |
|---|---|---|
| Calcium | Up to 2,000 mg/day | 4 doses of 500 mg |
| Iron | 60-120 mg/day | 1-2 doses of 60mg |
*Recommended dose size encourages absorption. Breaking up a dose throughout the day allows the body to absorb as much of the supplement as possible.
There are many statewide and local programs to support both families with lead-poisoned children and expecting parents. These include:
- The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). WIC supports people who are pregnant, breastfeeding, or postpartum, as well as infants and children up to age five. Foster parents and relatives may also apply on behalf of an infant or child in their care.
- The Well Badger Resource Center helps connect families to community, social, health, and government programs.
- Local Public Health Departments can help families get connected with local resources and programs.
- The Wisconsin Poison Center can help answer questions about lead poisoning and recommend next steps.