Frequently Asked Questions
Children enrolled in Medicaid are required to get tested for lead at 12 and 24 months, or between 24-72 months if they have not been previously tested.
Anyone that suspects that they or their child have been exposed to lead should be tested for lead poisoning, especially children under 6 years old. Children under 6 are particularly susceptible to lead poisoning because of their rapid development. They are also more likely to put their hands or other objects in their mouths. Children from low-income households and those living in homes built before 1978 are at the highest risk of lead exposure.
Pregnant women also have the risk of exposing their baby to lead prenatally. This exposure could result in premature birth, low birth weight, and slowed childhood development.
A blood test is typically performed to assess for lead exposure. There are two main types of tests. The capillary test is used as a quick, non-invasive screening test. The venous blood test is performed as a diagnostic test to confirm the results of a capillary test. The venous blood test is referred to as the “gold standard” for blood lead testing.
Urine lead tests can be used for detecting clinically significant lead exposure in the previous 24-hours. However, this is not a substitute for blood lead screening. If a patient receives a urine lead test, they should receive an accompanying blood lead test.
If children test at or above the CDC threshold of 3.5 µg/dL for a capillary test, a venous blood test is required for confirmation. Educational materials should be provided on how to limit further lead exposure.
Lead testing is a mandatory reportable condition under the North Dakota Administrative Code, Section 33-06-01-01.34. All blood lead test results must be reported to North Dakota Health and Human Services by laboratories or physicians, either electronically or via fax at (701) 328-2785.
Testing Guidelines
Confirmatory Venous Testing Schedule
If the initial capillary blood lead level is elevated, obtain a confirmatory venous test within the following timeframes:
• 3.5-9 µg/dL: within 3 months
• 10-19 µg/dL: within 1 month
• 20-44 µg/dL: within 2 weeks
• 45 µg/dL or higher: within 48 hours
Recommended Actions Based on Confirmed Venous Blood Lead Level
Less than 3.5 µg/dL
• Educational materials on sources of lead, lead exposure prevention, and a lead-safe diet should be provided to the parents or
guardians.
• At routine well-child visits, assess developmental milestones and discuss nutrition, with emphasis on vitamin C, iron, and calcium
intake.
• Continue blood lead testing according to age-based or risk-based screening recommendations.
3.5 to under 20 µg/dL
• An environmental exposure history should be collected to help the family identify potential sources of lead in their home.
• Provide education on lead-safe prevention, including information on lead-based paint, contaminated soil, lead water pipes, and other
sources of lead.
• Assess the child for iron deficiency and talk about the child’s diet with a focus on vitamin C, iron, and calcium.
• Monitor the child’s developmental progress and refer to supportive services when indicated. A second venous test should be
performed within 3 months.
• If the blood lead result remains at 10.0 or higher over a 3-month span, an environmental investigation will be conducted by the North
Dakota Department of Environmental Quality.
20 to under 45 µg/dL
• Perform a complete physical examination of the child, including an assessment for signs and symptoms associated with lead
exposure.
• Provide education on lead-safe prevention, including information on lead-based paint, contaminated soil, lead water pipes, and other
sources of lead.
• Talk to the child’s parent or guardian to make sure the child is getting vitamin C, iron, and calcium.
• An environmental investigation will be performed by the North Dakota Department of Environmental Quality.
45 µg/dL or higher
• Blood lead levels in this range should be addressed urgently.
• Perform a complete history and physical examination, including a detailed neurological exam.
• Consultation with a medical toxicologist, PEHSU, or Poison Control is recommended for management, including possible chelation
therapy.
• An environmental investigation will be carried out by the North Dakota Department of Environmental Quality.
Follow-Up Testing for Confirmed Venous Blood Lead Levels
CDC recommends the following follow-up schedule after an elevated blood lead level has been confirmed:
• 3.5 to 9.9 µg/dL: repeat in 3 months, then every 6-9 months as levels decline.
• 10 to 19.9 µg/dL: repeat in 1-3 months, then every 3-6 months.
• 20 to 44.9 µg/dL: repeat in 2 weeks to 1 month, then every 1-3 months.
• 45 µg/dL or higher: schedule a follow-up venous blood test within 48 hours.
CDC also notes that children in colder-climate areas may require more frequent follow-up during summer months due to seasonal increases in exposure.