Frequently Asked Questions
Children enrolled in Medicaid are required to get tested for lead at 12 and 24 months, or between 24-72 months if they have not been previously tested.
Anyone that suspects that they or their child have been exposed to lead should be tested for lead poisoning, especially children under 6 years old. Children under 6 are particularly susceptible to lead poisoning because of their rapid development. They are also more likely to put their hands or other objects in their mouths. Children from low-income households and those living in homes built before 1978 are at the highest risk of lead exposure.
Pregnant women also have the risk of exposing their baby to lead prenatally. This exposure could result in premature birth, low birth weight, and slowed childhood development.
A blood test is typically performed to assess for lead exposure. There are two main types of tests. The capillary test is used as a quick, non-invasive screening test. The venous blood test is performed as a diagnostic test to confirm the results of a capillary test. The venous blood test is referred to as the “gold standard” for blood lead testing.
Urine lead tests can be used for detecting clinically significant lead exposure in the previous 24-hours. However, this is not a substitute for blood lead screening. If a patient receives a urine lead test, they should receive an accompanying blood lead test.
If children test at or above the CDC threshold of 3.5 µg/dL for a capillary test, a venous blood test is required for confirmation. Educational materials should be provided on how to limit further lead exposure.
Blood lead reports can be sent to the North Dakota Office of the State Epidemiologist via FAX at (701) 328-2785.
Testing
IMPORTANT: Providers are required to report ALL Lead Tests. (Reportable Conditions information)
TABLE 1. Recommended time for venous blood test confirmation after receiving elevated capillary result (from CDC, 2022).
Blood Lead Level (µg/dL) | Time to Confirmation Testing |
≥3.5 – 9 | Within 3 months |
10 – 19 | Within 1 month |
20 – 44 | Within 2 weeks |
≥ 45 | Within 48 hours |
If a patient receives a venous blood lead result at or above 3.5 µg/dL, a follow-up test should be administered.
TABLE 2. Recommended follow-up testing time after receiving an elevated blood lead level from a venous test (from CDC, 2022).
Blood Lead Level (µg/dL) | Follow-Up Testing and Re-testing |
<3.5 | Retest at 1 and 2 years old. |
≥3.5 – 9 | 3 months |
10 – 19 | 1-3 months |
20 – 44 | 2 weeks-1 month |
≥ 45 | As soon as possible |
TABLE 3. Recommended clinical guidelines based on venous blood test results.
Blood Lead Level (µg/dL) |
|
<3.5 | Talk to patient and family about nutrition to ensure the child is getting enough iron, calcium, and vitamin C. Make sure the child gets screened based on Medicaid guidelines. |
≥3.5 – 19 | Ensure child is getting enough iron, calcium, and vitamin C. Encourage other siblings to be tested. Schedule appropriate follow-up tests. Arrange[NM1] for an environmental investigation of the home to identify any sources of lead exposure. |
20-44 | Perform complete history and physical exam, assessing for signs and symptoms of lead poisoning. Consider performing an abdominal x-ray to check for lead-based paint chips and any other forms of lead that may have been ingested. |
≥ 45 | Begin chelation therapy. Perform a complete physical and neurological exam. Perform an abdominal x-ray to check for lead-based objects ingested. If the patient exhibits signs or symptoms of lead poisoning (including confusion, weakness, seizures, coma, nausea, vomiting, and abdominal pain) admit them to the hospital. |