Childhood Lead Poisoning Guidelines for Clinicians

To assist clinicians with the prevention, detection, and medical management of childhood lead poisoning, the North Shore Health Department (NSHD) reviews current recommendations from leading resources including the U.S. Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American Congress of Obstetricians and Gynecologists and issues additional local guidelines when appropriate.

For further information or to consult with NSHD nursing staff, contact us at (414) 371-2980.

Lead Testing Recommendations

As of October 28, 2021, CDC uses a blood lead reference value (BLRV) of 3.5 micrograms per deciliter (µg/dL) to identify children with blood lead levels that are higher than most children’s levels. CDC recommends that healthcare providers use a venous draw for confirmatory BLL screening. If the initial screening test used a venous sample, the patient does not need another venous draw. If an initial capillary sample results as greater than or equal to the current BLRV of 3.5 µg/dL, please obtain a confirmatory venous sample for your client according to the timeline in the table below. The higher the blood lead level is on the initial screening capillary test, the more urgent it is to get a venous sample for confirmatory testing. Please visit this CDC webpage for additional information.



Testing of children: The NSHD follows these recommendations set forth by the Wisconsin Department of Health Services (DHS) regarding testing for lead in children.

Testing of pregnant or lactating women: The NSHD follows guidelines issued by the U.S. Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists (ACOG) regarding blood lead testing of pregnant or lactating women. The routine universal testing of all pregnant or lactating women is not recommended. Risk assessment of lead exposure should take place and blood lead testing should be performed if a risk factor is identified.

ACOG Lead Screening During Pregnancy and Lactation Recommendations
Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women

Reporting of Blood Lead Testing

State law Wis. Stat. 254.13 requires that all blood lead test results on Wisconsin residents be reported to the Wisconsin Department of Health Services (DHS). The specific requirements for reporting blood lead results, such as timetable, content, form, etc., are described in Wis. Admin. Rule 181. Health care providers are responsible for sending complete demographic information as required by Wis. Admin. Rule 181 to the analytical laboratory with each blood lead sample. This allows the laboratory to include the demographics in the blood lead report.

Medical Case Management of Blood Lead Levels

Childhood Lead Poisoning Case Management: All children who live in the North Shore and have a blood lead level of 3.5 micrograms per deciliter (µg/dL) or higher are eligible to receive a home visit by a North Shore Health Department nurse based on the blood lead level reported. Clinicians are advised to follow WI DHS guidelines for medical case management.