Protecting Children from Lead Exposure: The Importance of Lead Screening 
By: SPN’s Healthcare Policy and Advocacy Committee (HPAC)

Introduction 
There is no safe level of lead in the blood (Centers for Disease Control and Prevention [CDC], n.d.-a). Lead poisoning remains a serious public health concern, with long-term developmental and neurological consequences, particularly for young children. 

In 2016, approximately 59,000 U.S. children aged 1 to 5 had elevated blood lead levels of 3.5 μg/dL or higher (Jacobs & Brown, 2023). Children from racial and ethnic minority backgrounds and those from low-income households are disproportionately affected (CDC, 2021). Pediatric nurses play a vital role in early lead screening, education, and prevention efforts to minimize long-term health risks. 

Updated Lead Screening Guidelines 
In 2021, the CDC (n.d.-b) updated the blood lead reference value from 5 μg/dL to 3.5 μg/dL, based on National Health and Nutrition Examination Survey (NHANES) data. Children with blood lead levels at or above this threshold require further evaluation, environmental assessment, and possible medical intervention. For more information on interventions, visit the CDC website: CDC Lead Prevention Program. 

The Pediatric Nurse’s Role in Lead Screening 

Pediatric nurses play a crucial role in reducing childhood lead exposure through primary and secondary prevention efforts. 

Primary Prevention: Education and Risk Reduction 

• Assess environmental exposure risks during routine visits, particularly in homes built before 1978, which may contain lead paint and lead pipes.  

• Educate caregivers on the sources of lead exposure, including lead-based paint, contaminated water, and imported products. 

• Encourage safe household practices such as:  

• Use cold tap water for drinking and cooking 

• Regularly wet-wiping surfaces and mopping floors to reduce lead-contaminated dust

• Keeping children away from peeling or chipped paint in older homes. 

• Ensuring repairs in pre-1978 homes follow Environmental Protection Agency (EPA) guidelines

• Promote proper nutrition, emphasizing calcium, iron, and vitamin C to help reduce lead absorption. 

Secondary Prevention: Screening and Early Detection 
According to the CDC, the following children are at risk for lead exposure:

• Living in or frequently visiting homes built before 1978 

• Exposed to lead-contaminated water, soil, or household dust

• With parents or caregivers working in lead-related industries

• Recently immigrated or adopted from high-risk areas 

Blood screening guidance for lead poisoning prevention (Macrae, J. & Ikeda, R. M., 2023) 

Children enrolled in Medicaid must be tested for lead at: 

• 12 months of age 

• 24 months of age 

Testing for Children Without Prior Lead Tests: 

• Children between 24 and 72 months (2 to 6 years old) who have no record of a previous blood lead test 

Testing for Children at Higher Risk 

• All children identified as at higher risk for lead exposure should be tested according to state and local health department guidelines. 

Identifying children at higher risk and performing routine screenings are essential steps in detecting elevated blood lead levels early. For the latest lead screening guidelines, families should consult a healthcare provider or their local health department. 

Conclusion 
Prevention and early detection are important in addressing childhood lead exposure. Pediatric nurses collaborate with families and communities to raise awareness, promote screening, and provide guidance on follow-up care for children with elevated lead levels. Their efforts aim to reduce the long-term developmental and neurological effects of lead toxicity as they identify at-risk children and collaborate with public health agencies to create lead-free environments. 

The EPA offers a "Lead Poisoning and Your Children" Pamphlet for parents and caregivers, available in multiple languages. It is available athttps://www.epa.gov/lead/lead-poisoning-and-your-children-pamphlet 

References 

Childhood Lead Poisoning Prevention Branch (CLPPB). (2025). Childhood lead poisoning prevention program. California Department of Public Health.https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/CLPPB/Pages/CLPPBhome.aspx 

Centers for Disease Control and Prevention. (n.d.). People at increased risk for childhood lead poisoning. Centers for Disease Control and Prevention. https://www.cdc.gov/lead-prevention/risk-factors/?CDC_AAref_Val=https%3A%2F%2Fwww.cdc.gov%2Fnceh%2Flead%2Fprevention%2Fpopulations.htm  

Centers for Disease Control and Prevention. (n.d.-a). About the lead prevention program. U.S. Department of Health & Human Services.https://www.cdc.gov/lead-prevention/about/index.html 

Centers for Disease Control and Prevention. (n.d.-b). Blood lead surveillance data. U.S. Department of Health & Human Services.https://www.cdc.gov/lead-prevention/php/data/blood-lead-surveillance.html 

Centers for Disease Control and Prevention. (2021, October 28). CDC updates blood lead reference value to 3.5 µg/dL. U.S. Department of Health & Human Services.https://www.cdc.gov/lead-prevention/php/news-features/updates-blood-lead-reference-value.html 

Jacobs, D. E., & Brown, M. J. (2023). Childhood lead poisoning 1970-2022: Charting progress and needed reforms. Journal of Public Health Management and Practice, 29(2), 230–240.https://doi.org/10.1097/PHH.0000000000001664 

Macrae, J. & Ikeda, R. M. (2023). HRSA-CDC Letter on Childhood Lead Poisoning Prevention and Blood Lead Testing