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Required Lead Screenings – Every Child. Twice by Two.


DHCF AND DOEE JOINT LETTER TO ALL PEDIATRICIANS, FAMILY PRACTITIONERS, HEALTH CLINICS AND MANAGED CARE ORGANIZATIONS SERVING DC MEDICAID BENEFICIARIES:

Would you skip a simple blood test that could protect children from a lifetime of harm?

Less than a third of young children in the District of Columbia have received the two lead screenings required by District law, first between ages 6 and 14 months and again between ages 22 and 26 months. Missed opportunities in well-child visits to screen “Every Child, Twice by Two” leave children in the District at risk of serious and irreversible harm from lead exposure. Approximately 51,000 children less than six years (72 months) of age live in the District and are at risk of exposure to lead-based paint and other lead hazards.

The Department of Energy and Environment (DOEE) and the Department of Health Care Finance (DHCF) are sharing this reminder of the importance of childhood lead screening and of your legal obligation to perform lead screenings and to report lead-poisoned children to DOEE’s Childhood Lead Poisoning Prevention Program, as outlined below. To review your full responsibilities under the District’s lead screening and reporting law, please also visit hup://www.dcregs.dc.gov/Gateway/ChapterHome.aspx?ChapterN umber=22-B73.

Why screen for lead twice by the age of two?

Typically, children’s blood lead levels (BLLs) increase fastest between 6 and 12 months of age and peak at approximately 2 years of age. Babies and young children engage in more frequent hand-to-mouth activity that can expose them to lead and are most susceptible to the effects of lead. Since exposure may present no obvious symptoms, screening is essential to identify lead­exposed children that need environmental or medical intervention and case management to reduce their BLL. No safe blood lead level in children has been identified. Even levels below the reference value of 5 micrograms of lead per deciliter of blood (µg/dL) may cause lasting harm.

What are the District’s lead screening requirements?

District law requires that every child who resides in the District of Columbia receive a first BLL screening between 6 months and 14 months of age and a second BLL screening between 22 months and 26 months of age, upon obtaining parental consent, unless an identical test has already been performed in the previous 12 months. In addition, if a child over 26 months of age has not been tested, the law requires BLL testing at least twice before the child is 6 years of age.

When are additional lead screenings required?

District law also requires you to screen when a child is at risk for high-dose lead exposure, such as living in or frequently visiting deteriorated or renovated housing built before 1978 (presumed to include lead-based paint); having a household member who may be exposed to lead at work; or having neurological, behavioral, or developmental symptoms consistent with lead exposure.

When do you have to report an elevated BLL?

District law requires laboratories, including health care providers that use a blood lead testing device at the point of care, to immediately notify DOEE’s Childhood Lead Poisoning Prevention Program by telephone or fax if a child’s BLL is equal to or greater than 10 µg/dL. Health care providers that receive a report from a laboratory or another provider are required to report lead­poisoned children to DOEE’s Childhood Lead Poisoning Prevention Program within 72 hours. However, we ask that you report results to DOEE immediately if a child is identified with an elevated BLL equal to or greater than 5 µ,g/dL, so DOEE can take prompt action to mitigate risks for the family and provide the care the child needs. To report an elevated blood lead level, fax the result to DOEE’s secure fax line at (202) 535-2607 or call DOEE at (202) 654-6002. By law, laboratories and providers that use a blood lead testing device at the point of care must report all test results to DOEE, not just elevated results.

What else can you do to prevent lead exposure?

In addition to legal requirements for providing family lead education and referrals for social and environmental services when a child has an elevated blood lead level, you have the important responsibility for providing anticipatory guidance to pregnant women, parents/guardians, and their families about the protective steps they can take to prevent lead exposure.

Visit http://doee.dc.gov/node/613342 for helpful guidance you can share with those you serve.

For questions about lead screening, please contact Colleen Sonosky, Associate Director of DHCF’s Division of Children’s Health Services, at (202) 442-5913, or Lisa Gilmore, Chief of DOEE’s Lead-Safe and Healthy Housing Branch, at (202) 535-2624.

Thank you for all that you continue to do to protect children’s health in our nation’s capital.

Sincerely,