Lead Poisoning Information for Healthcare Providers

In Illinois, the Lead Poisoning Prevention Act and Lead Poisoning Prevention Code requires that any physician treating children aged 6 or younger must screen or test children for lead exposure.

Physicians and care providers must evaluate all children using The Childhood Lead Risk Questionnaire.

Physicians and care providers must conduct a blood lead test for any child who:

  • has a “yes” or “I don’t know” answer on the Questionnaire
  • lives in a designated high risk ZIP Code
  • who is Medicaid-eligible

The Illinois Department of Public Health (IDPH) recommends children meeting criteria for testing be tested at 12 and 24 months. According to Illinois law, all children 6 months through 6 years of age must be assessed for lead poisoning before entering childcare, preschool or kindergarten. It is important to reassess annually in case a family has relocated to another home.

IDPH also recommends, but does not require, evaluation and testing for pregnant persons. Providers can use the Prenatal Risk Evaluation for Lead Exposure, and consult IDPH for further information.

How should the blood be drawn?

The most reliable measure of a child’s blood lead is a venous test. Capillary draws may be used for screening, with the understanding that a capillary specimen can be contaminated by lead dust from a child’s hands. CDC does not recommend using a filter paper test, as it also can be contaminated by environmental lead. All capillary and filter paper results of ≥10 μg/dL should be repeated using a venous test collected into a lead-free tube.

Reporting requirements:

  • Any test ≥10 μg/dL must be reported to IDPH within 48 hours or receipt.
  • All tests under 10 μg/dL must be reported to IDPH within 30 days of the last day of the month that the test was administered.
  • Note that if the state lab processes the test results, if the provider has confirmation that their lab electronically reports all results to IDPH, then providers do not need file duplicate reports. Ultimately, the

provider has responsibility for reporting and must ensure that all lead reports are submitted to IDPH.

For children with blood lead levels ≥10 μg/dL, a CCDPH public health nurse will visit the home to teach parents housekeeping and hygiene to prevent further exposure, and CCDPH lead risk assessor will evaluate the building to identify lead hazards. CCDPH public health nurses will collaborate with primary care providers about medical issues and follow-up activities.

For children with blood lead levels BELOW 10 μg/dL, CCPDH can provide home inspection and case management services ONLY with a referral from a medical provider. To refer a child with a blood lead level below 10 μg/dL, sign and fax this form to 708-633-8090.

If a child has an elevated lead level, what should a health care provider do next?

The CDC recommends that providers conduct medical evaluation including the following:

  • Detailed history of symptoms, existence of pica, siblings with lead poisoning, potential sources of lead and previous blood lead results
  • Description of age and condition of all housing where the child spends time
  • Assess exposures to renovation in housing
  • Occupational histories of adults in the household to determine if the child is exposed to lead brought home from the workplace
  • Physical examination, with special attention to neurologic, psychosocial and language development.
  • Learning or developmental delays should prompt further assessment and referrals to appropriate programs
  • Evaluation of nutritional status, especially of calcium and iron
  • Children with higher BLLs may need chemical treatment. The U.S. Food and Drug Administration approves the use of succimer (Chemet®) for treating children with BLLs greater than 45 μg/dL. These children need to be
  • monitored more closely for at least one year until the BLL decreases. They should be seen by a physician every other week for eight weeks and, then, once a month for six months.
    • Educate parents on the meaning of the BLL and potential health effects
    • Discuss proper nutrition
    • Refer patients to other agencies to provide additional service

When should lead-poisoned children be retested?

Follow-up testing should take place, according to the IDPH recommendations on lead level.