Missouri Facts

  • Missouri is the #1 lead-producing state in the United States.
  • 21 percent of Missouri housing was built before 1950, when high lead-content paint was widely used.
  • Approximately 65 percent of Missouri housing was built before 1978 and may contain some lead-based paint.
  • Of the 92,920 children less than six years of age tested in FY2012, 728 had elevated blood lead levels (≥ 10 μg/dl). 4,672 children had blood lead levels between 5 and 9.9 μg/dL.

Recommendations and Requirements for Blood Lead Testing in Missouri

The Center for Disease Control (CDC) and the Association of Pediatrics work together to provide recommendations for blood lead testing. The Centers for Medicare and Medicaid Services (CMS)/Missouri Department of Social Services, Division of Medical Services and Department of Health and Senior Services have state requirements for the blood lead testing of children.

For more information on CDC and Association of Pediatrics blood lead test recommendations go to: http://www.pehsu.net/_Childhood_Lead_Exposure.html.

Who should be tested?

  • Children should be tested between 6 months and 3 years of age because children at this age spend a lot of time on the floor and often put things in their mouths. The hand to mouth behavior is one of the most common pathways for lead poisoning to occur. Testing is highly recommended for this age group if the child lives in or regularly visits a house that was built prior to 1978.
  • All siblings of a child who has an elevated lead level should be tested.
  • All children receiving Medicaid benefits are required to be blood tested for lead at 12 and 24 months of age.
  • Newborns of women who had suspected or elevated blood lead levels during pregnancy should be tested.
  • Children and pregnant women who reside in a pre-1978 home, which is undergoing renovation, may require more frequent blood lead testing during the renovation process and after renovations are completed.
  • If you are unsure if your child should be tested, consult your child’s physician.

Childhood Lead Testing Requirement Areas

The State of Missouri categorizes its testing areas into two designations:

  • High Risk also referred to as universal.
  • Non-High Risk, also referred to as targeted.

A testing designation is given to a geographic area based on a formula developed by the Department of Health and Senior Services. An area’s designation may change based on the yearly information provided by that area. These testing requirement designations assist physician’s offices, local health departments, and others in determining whether children are required or recommended to be tested for lead. Regardless of the designation in which you live, it is recommended that all children be screened and/or tested for lead annually.

The Department publishes the testing requirement area maps annually, in April. The testing requirement maps for the State of Missouri can be viewed at: http://health.mo.gov/living/environment/lead/maps.php.

Universal (High Risk) Area Requirements:

  • Any child under the age of 6 years will be blood lead tested annually if he/she lives in a universal (high risk) testing area.
  • Day care facilities are required to record a "proof of lead testing" signed by the Health Care Provider performing the test within thirty (30) days of the child's enrollment. If the parent/guardian does not provide it or a written statement stating why they do not want the child tested, the Day care facility is to offer the parent assistance in scheduling a test.

Targeted (Non-High Risk) Area Requirements:

  • Any child under the age of 6 years will be tested annually if he/she lives in a non-high risk testing area, but visits for more than 10 hours per week a universal (high risk) testing area.
  • Each child will be screened annually by the child’s physician using the HCY Lead Risk Assessment Guide to determine whether the child is at risk for lead poisoning.
    • If a positive answer is given, the child is considered at risk for lead poisoning and is recommended to have a blood lead test.

HCY Lead Risk Assessment Guide
Guía HCY de Evaluación de Riesgo por el Plomo <!--[Spanish translation] -->

Prenatal Lead Testing Information

  • Pregnant women should discuss lead risk exposure with their physician as part of the first prenatal visit.
  • Women should be screened by their physician using the Prenatal Assessment Questionnaire to determine whether she and the fetus are at risk for lead poisoning.
    • If a positive answer is given, the mother is considered at risk for lead poisoning and is recommended to have a blood lead test.

Prenatal Assessment Questionnaire

Methods of Testing

The choice of a sample collection method (venous or capillary) should be determined by the physician. Capillary sampling can perform well as an initial testing tool. If the results of the capillary are 10 μg/dL or greater, the capillary results should be confirmed with a venous blood draw.