Lead Poisoning Prevention Guidance for Health Care Providers

This information is for health care professionals. The Healthy Homes Lead Poisoning Prevention Program works with you to ensure that all 1- and 2-year-old children are tested for lead. Vermont law requires that all children are tested for lead at 12 months and 24 months. As of September 1, 2020, health care professionals must provide a copy of What Your Child’s Lead Test Means to all parents or caregivers of children being tested for lead, regardless of the test results.

Vermont has lowered its definition of an elevated blood lead result from 5 µg/dL to any reported level. Research highlights that there is no safe level of lead and levels at and below 5 µg/dL still impair development. Therefore, any level of lead in the blood is considered elevated.

Reporting Requirements

All blood lead results on Vermont residents are required by state law to be reported to the Vermont Department of Health. Most analytical laboratories report directly to the Health Department.

If you have a LeadCare II analyzer, you are required by state law to report all blood lead results on Vermont residents to the Health Department. Please call the Healthy Homes Lead Poisoning Prevention Program at 802-863-7220 or 800-439-8550 (toll-free in Vermont) for more information and procedures on how to report results.

Criteria for Testing Asymptomatic Children

These criteria are for testing asymptomatic children at well child visits and do not apply to children previously or currently lead poisoned:

Test all children at 12 months and 24 months.
Test all children ages 36 to 72 months who have not been previously tested.
For refugees: test all children ages 6 months to 16 years old upon entry to the U.S. Perform a follow-up blood lead test on all refugee children ages 6 months to 6 years within three to six months, regardless of initial test result.
Other at-risk populations: International adoptees, immigrants, children of migrant workers, children in foster care, and children diagnosed with pica or special health needs that increase hand-to-mouth behavior.

Review the Pediatric Blood Lead Testing and Case Management Guidelines

Other indications to test for lead

Blood lead testing should be considered part of a diagnostic work-up of any child, regardless of age, with any of the following:

Ingestion of an object that may contain lead
Signs or symptoms consistent with lead poisoning
Living in an older home undergoing renovations
Living with someone who has a blood lead level of 5 µg/dL or greater
Children at-risk: international adoptees, immigrants, entering foster care or who have pica or special health needs that increase hand-to-mouth behavior

When to Confirm with a Venous Test

Capillary levels at or above 3.5 µg/dL need to be confirmed by venous sampling.
Capillary levels below 3.5 µg/dL (micrograms per deciliter), but greater than the detection limit should be monitored over the next 6 months.

The Health Department provides education and initiates case management for venous confirmed elevated blood lead levels. The higher the capillary test result, the more urgent the need for a confirmatory venous test. It is preferable to confirm as early as possible. See the guidelines in the table below.

If Capillary Blood Lead Level is:	Confirm with Venous Test Within:
No detected lead (DL)	Confirmation not needed
Any DL – 3.4 µg/dL	Within 6 months (capillary sample or venous)
3.5 – 9 µg/dL	Within 3 months
10 – 19 µg/dL	Within 1 month
20 – 44 µg/dL	Within 2 weeks
45 – 59 µg/dL	48 hours
60+ µg/dL	Immediately as an emergency test

Resources and Patient Information

Accessing your patients' blood lead test results

New Users: Please sign the Provider Confidentiality Agreement and fax to 802-863-7483 or email to [email protected].

Patient Profile, commonly called the Immunization Registry, is an application that is a confidential, web-based system that provides a means for collecting and sharing data related to immunizations as well as results of childhood hearing screening, newborn metabolic screening, blood lead screening, and developmental screening.

Access to the Blood Lead Program will allow you to view patient records or run reports:

Individual Patient Record – provides a complete history of reported blood lead results for a patient
Screening Tests Needed Report – lists patients in your practice who are due or overdue for their 12-month or 24-month lead tests, and patients between the ages of 36 and 72 months who have never had a lead test
Venous Follow-Up Tests Needed – lists patients in your practice who need venous confirmation tests and those who are in case management

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Resources for you and educational materials for patients

Title	Description
Pediatric Blood Lead Testing & Case Management Guidelines	Review Health Department guidelines for blood lead testing and case management procedures from the initial blood lead test through clinical treatment for venous confirmed blood lead levels ≥ 5 µg/dL.
Blood Lead Analysis and Sample Collection Resources	Check this resource sheet for options available to health care providers for blood lead testing and analysis.
Capillary Blood Lead Specimen Collection Instructions	View instructions on how to prepare, collect and submit a capillary blood lead sample to the Health Department Laboratory.
Lead Poisoning Prevention Guidance for Parents	This web page has a variety of information and resources for parents on sources of lead, lead poisoning prevention, lead testing and lead-safe practices.
How would you know? 8.5x11 poster How would you know? 11x17 poster	How would you know if your child had lead poisoning? This poster can be printed and displayed by providers to encourage parents to have their children tested.
Lead in Paint	This fact sheet for parents has information on how to find out if a home has lead-based paint and how to reduce a child’s risk of lead poisoning.
Lead in Soil	This fact sheet for parents has information on possible sources of lead in soil, how to test soil for lead, and how to protect children.
Lead in Drinking Water	This web page has information about lead in drinking water and how to test for it and a fact sheet for parents.
Lead and Your Job: What Adults Should Know About Lead Poisoning	This fact sheet is for a parent who works with lead and explains how to reduce occupational lead exposure and how to reduce a child’s exposure to "take-home" lead.
Poster: Lead-Free Kids for a Healthy Future	Display this 11x17 poster that outlines keeping homes lead-safe, testing children for lead, and getting the facts on lead poisoning in your office.
Pregnancy and Lead Poisoning	This fact sheet has information on the health effects of lead on pregnant people and fetuses, how to protect fetuses before birth, and possible lead exposures.
Blood Lead Exposure Risk Assessment for Pregnant and Breastfeeding Women	Use this brief questionnaire when assessing lead risks for pregnant women.
Lead Hazards and Lead Poisoning	Refer to this web page for information on potential lead exposures.
Lead Poisoning Prevention	This fact sheet for parents is on the basics of lead poisoning prevention.
Blood Lead Testing and Reporting Rule	Refer to this rule for requirements on when to test for lead and how to report blood lead test results.
What Your Child's Lead Test Means	This fact sheet for parents explains the difference between capillary and venous lead tests, what the result means, and what to do when they receive the result.
Funding Assistance for a Healthier Home	This webpage lists programs that offer financial assistance for fixing environmental health problems, including lead, in homes.