• The Center for Disease Control (CDC) and the Association of Pediatrics work together to provide recommendations for blood lead testing in the U.S. The Centers for Medicare and Medicaid Services (CMS)/Missouri Department of Social Services; Division of Medical Services and Department of Health and Senior Services (DHSS) have state requirements for blood lead testing of children.
  • Medical Management of Childhood Lead Exposure and Poisoning Recommendations for Health Professionals (PEHSU).
  • Children should be tested between six months and 72 months of age as they are at an increased risk due to neurological development. Children between the ages of six months and three years are also at a higher risk because they spend a lot of time on the floor and often put things in their mouths. This hand-to-mouth behavior is one of the most common pathways for lead poisoning to occur. Testing is highly recommended for this age group, especially if the child lives in or regularly visits a house that was built prior to 1978 or in a lead mining community.
  • All siblings of a child who has an elevated blood lead level should be tested.
  • All children receiving Medicaid benefits are required have lead testing 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.
  • DHSS recommends all children six months to 72 months of age be tested. If you are unsure if your child should be tested, consult your child’s physician.

Childhood Lead Testing Requirement Areas

  • Regardless of the designation in which you live, it is recommended that, annually, all children six months through 72 months of age be screened and/or tested for lead.
  • The State of Missouri has designated areas of the state into two categories based on geographically identifiable risk factors:
    • High Risk – Areas of the state that have geographically identifiable increased risk factors.
    • General Risk – Areas that may pose a risk of lead poisoning but that have not been identified as high risk.
  • See maps indicating these designated areas.

High Risk Testing Area Requirements

  • Children less than 72 months of age who reside or spend more than ten hours a week in an area identified as high risk by the department shall be tested annually for lead poisoning.
  • Every child care facility affiliated with a school system, a business organization or a nonprofit organization shall, within 30 days of enrolling a child, require the child’s parent or guardian to provide evidence of lead poisoning testing in the form of a statement from the health care professional that administered the test or provide a written statement that states the parent’s or guardian’s reason for refusing such testing.

General Risk Testing Area Requirements

Prenatal Lead Testing Information

  • Pregnant women and women who work with lead 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.

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 5 μg/dL or greater, the capillary results should be confirmed with a venous blood draw.