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State health department recommends blood tests for lead poisoning for all children under 5

The state health department is recommending that all children be tested at age 1 and again at age 2 for lead in their bloodstream, and testing for children ages 3 to 5 who haven’t been previously tested.

The recommendation for universal testing follows new federal guidelines, which now recommend testing all children for lead, according to the Wisconsin Department of Health Services (DHS).

Kirsten Johnson, Wisconsin Department of Health Services (DHS) secretary-designee. (DHS photo)

“Universal testing ensures all children can grow up healthy and lead-free,” said DHS Secretary-designee Kirsten Johnson at a briefing for reporters Thursday.  “Lead can hurt anyone, but it’s especially dangerous for young children because their bodies and brains are going through significant development.”

Younger children who are crawling and learning to walk are more likely to be exposed to soil and dust contaminated with lead. “Children this age often put objects or their hands into their mouths, which can cause a child to ingest lead over time and can poison them,” Johnson said.

Previous guidelines focused on testing children who were considered at higher risk for lead poisoning.

Exposure to lead-based paint is the most common risk factor in Wisconsin, said Brian Weaver, the lead policy adviser at DHS. Past guidance targeted children living in homes built before 1950 or in homes built before 1978 that had been recently renovated, he said, along with other criteria.

In addition, federal rules for Medicaid require blood lead testing for all children ages 1 and 2 who are covered by the health insurance program for low-income families.

By broadening the guidelines to recommend testing for all 1- and 2-year-olds, DHS is hoping to streamline the process for parents and health care providers. “It’s really simplified, made it more consistent, much easier to understand and also to implement in the clinical setting for health care providers,” Weaver said.

Wisconsin law doesn’t authorize DHS to require testing for all children, however, he said.

Milwaukee has historically accounted for a significant majority of lead poisoning cases in Wisconsin, with lead house paint and lead water pipes among the principal sources of contamination.

Cities including Milwaukee have begun replacing lead pipes using federal funds authorized under the 2021 bipartisan infrastructure law. DHS also administers a lead-safe home program that provides lead-remediation grants for the homes of families on Medicaid.

Lead poisoning isn’t limited to the state’s largest city, however. “Every county in Wisconsin has had a lead-poisoned child in the last five years,” Weaver said. “So this is a statewide issue. People who are living in rural and suburban environments need to be aware of that.”

A recent FDA recall of applesauce contaminated with lead also illustrates the potential for risk beyond the commonly cited sources of lead poisoning, he added.

Every county in Wisconsin has had a lead-poisoned child in the last five years. So this is a statewide issue.

– Brian Weaver, DHS lead policy advisor

About 20% of Wisconsin children age 5 or younger have been tested, Weaver said. Through 2019, more than 80,000 children a year were tested for lead, according to DHS. The number dropped in 2020 to about 60,000 and has been slowly increasing since.

Weaver said an estimated 75,000 kids were tested in 2023, and 3.2% of them were found to have lead levels of 5 micrograms per deciliter of blood or more.

While no amount of lead in the blood is considered safe and even small amounts can lead to brain damage and developmental delays, the Centers for Disease Control and Prevention (CDC) has set a level of 3.5 micrograms per deciliter as a threshold for elevated blood levels. 

Wisconsin law still sets 5 micrograms as the minimum level for lead poisoning. The Republican majority on the state Legislature’s budget committee deleted a proposal in Gov. Tony Evers’ draft 2023-25 budget lowering that to 3.5 micrograms.

All blood lead tests must be reported to the state. DHS records the number of tests at or above 3.5 micrograms in order to comply with the CDC guidelines, Weaver said, as well as the number at or above 5 micrograms.

DHS is directing its universal testing message to parents as well as health care providers, particularly community-based providers whose practice includes children and Medicaid providers. In addition, Weaver said, the department is putting the word out to other agencies, such as those that carry out Women Infants Children (WIC) programs and agencies that work to address lead hazards in homes.

Johnson, who directed the Milwaukee Health Department before her appointment last year to lead DHS, said that in Milwaukee doctors’ and WIC agencies “do a really good job” of seeing that children enrolled in Medicaid were tested.

Johnson said that she and her family, including three children, have always lived in homes built before 1950. With her background in public health, she had them tested for lead when they were young, she said.

With universal testing, DHS is “trying to make the decision easier for the provider,” Johnson said, “but also trying to give parents the information and empower them to ask for their children to be tested.”

DHS is seeking “a significant increase in blood testing,” a goal that will take some time, Weaver said. The test can cost from $10 to $75. The cost is covered for Medicaid patients, and insurance carriers will reimburse patients for at least some of the cost, he said.

The health department expects to see more evidence of childhood lead poisoning as more children not previously considered to be at risk are tested. “One of the reasons behind changing this recommendation is to make sure that we are finding all children who are lead poisoned out there so they can receive the necessary follow-up and care,” Weaver said.

Local health departments are likely to play an important role in providing follow-up care, Weaver said, and DHS staff members can provide technical assistance and funding, including reimbursement through Medicaid, to help them. 

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originally published at https%3A%2F%2Fwisconsinexaminer.com%2F2024%2F01%2F19%2Fstate-health-department-recommends-blood-tests-for-lead-poisoning-for-all-children-under-5%2F by Erik Gunn

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