Targeted-screening Recommendations

In 1991, the CDC recommended universal (yearly) testing of all children through 72 months of age. In 1997, the CDC urged local health departments to determine targeted screening guidelines based on an evaluation of local housing, poverty, and past testing data.

The Douglas County Health Department Childhood Lead Poisoning Prevention Program makes the following recommendations for testing children for lead exposure based on these concerns:

• Studies continue to demonstrate that even low-level exposure can cause damage.
• Children continue to have many different routes of lead exposure in Douglas County.
• A child's risk level is a complex combination of behavioral and environmental factors and can change quickly as the child develops or has a change of environment.
• Children are most at risk 0 to 3 years of age, with risk tapering off through 6 years.
• Most children do not exhibit overt symptoms during lead exposure, but damage can be occurring, with the effects becoming evident once the child is in school
• Until lead exposure can be prevented, children need to be screened to assure sources of exposure are being adequately controlled.
• The best opportunity to positively impact the outcome of lead exposure occurs with early detection and intervention.

Targeted Screening Guidelines for Douglas County Nebraska

February 1998 (Update November 2001)

• Health providers should use a blood lead test to screen all children at approximately 12, 24, and 36 months of age, or at the first visit after 9 months if no prior test record available.
• Children between 36 and 72 months of age should be assessed for risk of present and past exposure using the attached questionnaire. Any question answered yes or unknown should trigger a blood lead test.
• Every time a child accesses care, providers should evaluate risk and need for testing.
• Children with a change in their risk status (renovations, change of address for family or caregivers, etc.) and those children observed mouthing or ingesting items of concern may benefit from additional screening.

Children that have had a prior test > 10 ug/dL should be retested as recommended in the CDC guidelines for responding to blood lead levels in children, 1991 and 1997.

All lead tests are reportable in Nebraska and are to be reported to the state or local health department. Guidelines for case management of EBLs, reporting, and other information regarding childhood lead poisoning are available from:

Douglas County Health Department Childhood Lead Poisoning Prevention Program

1819 Farnam, Room 400, Omaha, NE 68183 (402) 444-7825