Lead-Safe Wisconsin: Health Care Guidance for Adults and Children
Guidance for children
The CDC (Centers for Disease Control and Prevention) has determined that there is no safe level of lead in the blood. Screening programs are the best way to identify children who are at risk for lead poisoning. If a capillary screening test shows elevated blood lead levels, CDC and the Department of Health Services (DHS) recommend performing venous testing to confirm the result.
Children identified as lead poisoned should undergo regular health monitoring and follow-up blood lead testing. Because lead exposure’s effects often aren’t seen until later in life, this includes monitoring a child’s developmental milestones. It also includes nutrition evaluations.
See the CDC’s page on recommended actions based on blood lead level for information on:
- Schedules for follow-up blood lead testing.
- Recommendations for follow-up and case management for children.
Information for medical providers
- Blood Lead Levels in Children (PDF)
- Recommendations on Medical Management of Childhood Lead Exposure and Poisoning
- Wisconsin Blood Lead Screening Recommendations (PDF)
- Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention (PDF)
Information to share with families
- 5 Things You Can Do to Help Lower Your Child’s Lead Level (PDF) (Spanish version)
- Are You Pregnant? Prevent Lead Poisoning: Start Now (PDF) (Spanish version)
- Fact Sheet: Childhood Lead Poisoning: What You Should Know About Your Child’s Blood Test Results
- Lead Poisoning Home Checklist (PDF)
- Look Out for Lead, P-44535a (PDF)
Identifying Infants and Young Children with Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening
All children need well-balanced meals so they can grow and develop as they should. Consuming plenty of vitamins and minerals—especially calcium, iron, and vitamin C—can help reduce the amount of lead kids absorb.
Here are examples of foods that contain these important vitamins and minerals:
- Examples: milk, cheese, yogurt, kale, collards, turnip greens, canned salmon, and sardines with bones
- Examples: lean meats and poultry, seafood, cereals, and breads fortified with iron, peanut butter, nuts, dried beans and peas, raisins, prunes, prune juice, greens such as broccoli and spinach
Nutrient: vitamin C
- Examples: tomatoes, oranges, grapefruits, juices, juices fortified with vitamin C, strawberries, kiwi, green peppers, watermelon, cantaloupe, and potatoes
People with an iron deficiency absorb two to three times more lead than people with enough iron in their blood. Iron and lead interact and compete in heme synthesis. Even slight decreases in hematocrit can lead to increased lead absorption.
Many 1- and 2-year-olds in the United States don’t take in enough iron. This can lead to lasting cognitive development effects when they’re exposed to lead.
For more information on diagnosing an iron deficiency, view Chapter 8: Medical Management of Lead Poisoning Children in our Wisconsin Childhood Lead Poisoning Prevention and Control Handbook, P-00660 (PDF).
Nutrition support information for eligible families of children with lead poisoning
- WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) offices in Wisconsin
- Lead and a Healthy Diet: What You Can Do to Protect Your Child (PDF)
- Chapter 4 of Childhood Lead Poisoning Prevention: Guidelines and Recommendations
- Recommendations to Prevent and Control Iron Deficiency in the United States (PDF)
Guidance for adults
Most adults with elevated BLLs (roughly 94%) are exposed to lead in the workplace. They can bring lead dust home with them, which can cause children to be exposed. In fact, around two to three percent of children with BLLs of 10 µg/dL or more were exposed to lead this way.
Learn about lead testing in adults, P-01293
Ask about your patient’s work at their visits. Include questions like:
- What type of work do you do? What products or services does your company make or provide?
- What are your usual job tasks? How much time do you spend doing each task? Are there any workplace health and safety concerns? What are these concerns?
- Are you currently exposed to chemicals, dusts, or metals that may contain lead? Have you been exposed in the past?
- Are any of your co-workers working similar job tasks as you?
- Do you think your health problems may be related to work?
- What does your company do to protect your health and safety?
- Do you use any personal protective equipment (PPE) like gloves or respirators? For what tasks do you use PPE?
- Do you have any hobbies that involve working with lead, such as casting bullets or fishing sinkers, home remodeling, target shooting at firing ranges, stained-glass making, or auto repair?
If your patient has a family, encourage them to shower before leaving work, if possible, and wash their work clothes in a separate load of laundry.
Talk to your patients about being tested for lead poisoning
- Testing is important for patients whose work, hobbies or housing expose them to lead. Recommend testing household members if there is any concern about second-hand, or “take-home lead” exposure through clothes, vehicles, or equipment..
Pay special attention to patients who are pregnant, breastfeeding, or planning to have a child
- Talk to your patients about what they can do to stay safe while at work.
- Talk to your patients about how soon after birth they plan to return to work and their plans for breastfeeding.
- Recommend special protective measures or medical removal for an employee who is pregnant or who is planning to conceive a child when, in your judgment, continued lead exposure at the current job would pose a significant risk.
Learn more about the CDC’s Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women (PDF).
Here are the management guidelines for BLLs in adults according to the Council of State and Territorial Epidemiologists:
- BLL monitoring should be performed on a scheduled basis, depending on the person’s risk of exposure.
- Primary management of lead poisoning is identifying the source and eliminating or reducing it.
- A single BLL doesn’t reflect cumulative body burden or predict long-term effects, meaning chronic low-level lead exposure can have harmful health effects in adults.
- Treatment decisions, including those around chelation therapy, should be made in consultation with a physician knowledgeable about lead poisoning medical management.
< 3.5* µg/dL BLL
- No action needed. Monitor BLL if ongoing exposure.
* The National Institute of Occupational Safety and Health (NIOSH), part of CDC’s research and recommendation body, defines an elevated BLL at 5µg/dL or greater for adult blood lead surveillance reporting purpose. NIOSH’s definition generally applies to adults aged 16 years and older. The Council of State and Territorial Epidemiologists (CSTE) is CDC’s field partner in public health surveillance. In December 2021 CSTE recommended using a blood lead reference value (BLRV) of 3.5 µg/dL to identify populations at high risk of lead poisoning, regardless of age. CSTE’s BLRV is consistent with CDC’s recommended threshold level for detecting most individuals particularly children. Providers may use their discretion in determining whether to adopt more precautionary measures for patients with a BLL between 3.5-4.9 µg/dL.
3.5-9 µg/dL BLL
- Discuss health risks. Minimize exposure. Monitor BLL.
- Consider removal for pregnancy and certain medical conditions.
10-19 µg/dL BLL
- Decrease exposure. Remove from exposure for pregnancy. Monitor BLL.
- Consider removal for certain medical conditions.
20-29 µg/dL BLL
- Remove from exposure for pregnancy.
- Remove from exposure if repeat BLL in four weeks remains greater than or equal to 20 µg/dL.
- Recommend annual lead medical exam.
30-49 µg/dL BLL
- Remove from exposure. Prompt medical evaluation.
50-79 µg/dL BLL
- Remove from exposure. Prompt medical evaluation.
- Consider chelation therapy in patients with significant symptoms.
Greater than or equal to 80 µg/dL BLL
- Remove from exposure. Urgent medical evaluation.
- Chelation therapy may be needed.
Learn about current Occupational Safety and Health Administration (OSHA) lead standards.
- Labs must report all BLLs to DHS.
- Health care providers must include required demographic information the lab isn’t likely to have, including the person’s employer name, employer address, and occupation.
- The lab reports employer and occupation information in its Laboratory Results Report within the HL7 message (often NK1-13 and NK1-10 fields).
Learn more about blood lead reporting requirements.
- Keep Your Family Safe: Don’t Bring Lead Home from Your Job, P-01737 (PDF)
- Lead and Your Health, P-01738 (PDF)
- Lead Testing: Also Important in Adults, P-01293 (PDF)
- Training and medical guidelines – CDC
- Lead & Other Heavy Metals – Reproductive Health – CDC
- Summary: Provisions of the OSHA Lead Standard for General Industry, P-01802 (PDF)
- Construction – OSHA
- General industry – OSHA
Resources from other states
- Prevent Lead Exposure at Work from the California Department of Public Health
- Hazardous Substance Fact Sheet from the New Jersey Department of Health (PDF) (Spanish version)
If you have questions, call the Wisconsin Adult Lead Program at 608-266-1120 or email firstname.lastname@example.org.