Recommendations for blood lead screening of Medicaid-eligible children aged 1-5 years: an updated approach to targeting a group at high risk

Abstract

Lead is a potent, pervasive neurotoxicant, and elevated blood lead levels (EBLLs) can result in decreased IQ, academic failure, and behavioral problems in children. Eliminating EBLLs among children is one of the 2010 U.S. national health objectives. Data from the National Health and Nutrition Examination Survey (NHANES) indicate substantial decreases both in the percentage of persons in the United States with EBLLs and in mean BLLs among all age and ethnic groups, including children aged 1--5 years. Historically, children in low-income families served by public assistance programs have been considered to be at greater risk for EBLLs than other children. However, evidence indicates that children in low-income families are experiencing decreases in BLLs, suggesting that the EBLL disparity between Medicaid-eligible children and non--Medicaid-eligible children is diminishing. In response to these findings, the CDC Advisory Committee on Childhood Lead Poisoning Prevention is updating recommendations for blood lead screening among children eligible for Medicaid by providing recommendations for improving BLL screening and information for health-care providers, state officials, and others interested in lead-related services for Medicaid-eligible children. Because state and local officials are more familiar than federal agencies with local risk for EBLLs, CDC recommends that these officials have the flexibility to develop blood lead screening strategies that reflect local risk for EBLLs. Rather than provide universal screening to all Medicaid children, which was previously recommended, state and local officials should target screening toward specific groups of children in their area at higher risk for EBLLs. This report presents the updated CDC recommendations and provides strategies to 1) improve screening rates of children at risk for EBLLs, 2) develop surveillance strategies that are not solely dependent on BLL testing, and 3) assist states with evaluation of screening plans.