Provider Information
- Which children are required to be tested in Oklahoma?
- What are some common sources of lead exposure?
- What symptoms should I be looking for?
- What are the adverse health effects of lead poisoning?
- Am I required to report my blood lead testing results?
- Are there any facts sheets or brochures I can share with my patients?
- When do I use the Lead Exposure Risk Assessment Questionnaire (LERAQ)
Per state statute, Oklahoma is a universal screening state which means that all children are required to have a blood lead test at 12 months of age and again at 24 months of age. This means any child residing in Oklahoma, regardless of their Medicaid status, age of housing, or other known risk factors. If a child is under the age of six and has not had a previous blood lead test, the child should also receive a blood lead test.
Sometimes, children may need an additional blood lead test during other clinic visits. To assist you in identifying when a child needs an additional blood lead test, we have created a Lead Exposure Risk Assessment Questionnaire called the LERAQ. This questionnaire is available in English and Spanish. However, this questionnaire is not a substitute for the required testing that must occur at age 12 months and 24 months. Some of the reasons for testing a child at times other than their 12 month and 24 month checkups include:
- Sibling or playmate has recently had an elevated blood lead level
- Child has recently emigrated or returned from visiting another country which might have a higher incidence of lead poisoning
- Family has recently moved to an older home with paint in poor condition or has begun remodeling an older home
- Family or household member works with lead in their occupation or hobby
- Child has pica and might be chewing on or mouthing objects that could contain lead
LERAQ responses can also aid in identification of a child's potential lead exposure hazard. Educational materials and preventive guidance may then be tailored to the potential lead exposure hazard of the child.
Children on Medicaid require a blood lead test at 12 and 24 months as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) checkup. Children also require, or must provide evidence of, a blood lead test prior to enrollment in Head Start programs.
What are some common sources of lead exposure?
Although lead is no longer used in household paint, gasoline, and many consumer products, many sources of lead still exist and thus pose a health hazard.
Lead-Based Paint and Lead Contaminated Soil and Dust
The most common source for childhood lead poisoning is still residential lead-based paint. Lead-based paint hazards, leaded paint chips, and lead-contaminated dust are produced as the paint deteriorates and may be released into the environment. Children are most often exposed to lead when the lead-contaminated dust gets on their hands or toys and is then transferred to their mouths. Sometimes children may be exposed by eating leaded paint chips or inhaling leaded dust. Deteriorating exterior lead-based paint may be deposited in soil around the home. Children can be exposed outside the home by playing in the contaminated bare soil or inside the home if the contaminated soil is brought inside on household members' shoes or by the family pet.
The prevalence of lead-based paint varies depending on the age of the home. According to estimates from the 2011 American Health Homes Survey (AHHS), 86% of homes built before 1940 contain lead-based paint. For homes built from 1940-1959, 66% have lead-based paint present. The prevalence of lead-based paint for homes built in 1960-1977 declines to 25% of homes. In 1978, the use of residential lead-based paint was banned in the United States.
According to the Centers for Disease Control and Prevention (CDC), deteriorated leaded paint and elevated levels of lead contaminated house dust can be found in an estimated 24 million U.S. housing units. More than 4 million of these units are homes to one or more young children.
Lead in Water
Houses containing lead pipes or pipes soldered or welded together with metals containing lead, may have high lead levels in drinking water. According to the U.S. Environmental Protection Agency (EPA) homes built before 1986 are more likely to contain lead pipes, fixtures, and solder. Lead may enter tap water through corrosion of plumbing or plumbing fixtures. Corrosion is a reaction between the water and the lead pipes or solder. Dissolved oxygen, low pH (acidity) and low mineral content in water are common causes of corrosion.
See the Lead In Water page for more information and for lead in water resources.
Take-Home Sources and Hobbies
It is important to note that children can be exposed to lead hazards through “take home” sources. In other words, lead particles brought home on the clothes, shoes, or hands of an adult who works in an occupation that exposes him/her to lead. At work, people are usually exposed by breathing in air that contains lead particles. Families of workers may be exposed to higher levels of lead when workers bring home lead dust on their work clothes and shoes.
Work that involves industrial paint (which may still contain lead) such as painting or scraping bridges or water towers, cable splicing, construction, mining, radiator repair, recovery of gold and silver, repair and reclamation of lead batteries, smelting, welding, working on firing ranges and oil fields, and manufacturing bullets, ceramic tiles, electrical components, and lead batteries, are some of the occupations where workers may be exposed to lead.
Children may also come in contact with lead and be lead poisoned through household member's hobbies and leisure activities such as making stained glass with lead, pottery with lead glaze, making or reloading bullets and fishing sinkers with lead, and refinishing furniture and painting with lead-based varnishes.
Lead in Toys
Children may be exposed to lead from toys that have been made in other countries and imported into the United States or from antique toys and collectibles passed down through generations. Lead may also be found in older toys made in the United States. The U.S. Consumer Protection Safety Commission (CPSC) is responsible for announcing recalls of toys which contain excessive levels of lead and could result in adverse health effects.
Recalled toys that show signs of wear (chipped or peeling paint) or have cracked or broken parts are of special concern. Children are at the greatest risk from lead exposure and children under 36 months of age are particularly susceptible because of this age group's normal hand-to-mouth behaviors.
Please also refer to National Center for Healthy Housing (NCHH) fact sheets: Toys and Childhood Lead Exposure and Testing for Lead in Consumer Items for Children for additional information on toys and lead hazards.
Home Health Remedies, Imported Cosmetics, and Pottery
Certain traditional home health remedies contain lead. Greta and Azarcón are used by Hispanic communities to treat upset stomach or indigestion. Pay-loo-ah is used within the Hmong community and given to children as a cure for rash or fever. Certain Asian remedies are also found to contain lead such as Bali Goli, Ghasard, and Kandu.
Kohl (also known as Kajal or Surma) is used by Middle Eastern and South Asian communities. It is a traditional cosmetic used as an eyeliner, however, it contains high levels of lead. Sindoor powder which if often used a symbol of matrimony in Hinduism may also contain high amounts of lead.
Lead may also leach into food if it is put into improperly glazed pottery or ceramic ware usually made outside the United States (especially bean pots from Mexico or tagines from Morocco). Some vintage or antique plates and dinnerware may also contain lead in the glaze or painted surfaces, so country of origin is not always an indicator of potential lead in a product.
Leaded Mini Blinds
In 1996, the CPSC issued a warning that some imported vinyl (plastic) mini blinds manufactured in China, Taiwan, Mexico, and Indonesia may present a lead poisoning hazard for young children. Lead is used as a fixative in the vinyl. As the vinyl deteriorates when exposed to sunlight and heat, it forms lead dust on the surface of the blinds that children can get on their hands and then in their mouths. New mini blinds should always be in a box labeled "Lead Free." Some homes may still have leaded mini blinds installed prior to 1996.
What symptoms should I be looking for?
There are likely no noticeable symptoms of lead poisoning in children or adults, unless the lead level is extremely high (usually >45 µg/dL). This is why obtaining a simple blood lead test is the only true way to know if a patient has lead in their system. If there are symptoms, they are likely to be as follows:
Children
- Loss of appetite
- Vomiting
- Diarrhea
- Stomach cramps
- Constipation
- Learning problems
- Difficulty in sleeping
- Anemia
Adults
- Stomach pain
- Fatigue
- Decreased libido
- Headache
- Irritability
- Muscle or joint pain
What are the adverse health effects of lead poisoning?
Children
- Learning disabilities
- Language and behavioral problems
- Lower I.Q.
- Attention deficit disorder
- Hearing loss
- Anemia
- Muscle weakness
- Damage to nervous system and kidneys
- Death by lead poisoning is uncommon but can happen
Adults
- Hypertension (High Blood Pressure)
- Hearing loss
- Infertility
- Anemia
- Peripheral neuropathy (damage to nerves supplying sensation to arms and legs)
- Damage to nervous system and kidneys
Am I required to report my blood lead test results?
If you are using a point-of-care blood lead testing device such as the LeadCare® II by Magellan, then you are required to report ALL results obtained from the device to our program. Result reports are required to be submitted electronically through a secure website. Please click on this link for the user guide. Results must be reported monthly, or more often if the level is elevated.
If you use a reference lab for testing of blood samples or send your patients to a lab to obtain blood lead testing, then the laboratory is required to report the results to both you, as the ordering provider, and to our program. We do ask that you fax us copies of any blood lead results of 20 µg/dL or greater within 24 hours. This is because we can offer an environmental investigation to the patient's family to help determine the lead exposure source. If a child has a lead level of 45 µg/dL or greater (on a confirmed venous test) then that child may need chelation. Please call our office if you have a child with a very high lead level so we can coordinate your discussion of the case with a pediatric toxicologist who can advise you on next steps.
Are there any fact sheets or brochures I can share with my patients?
We try to keep updated information on our website that you can share with your patients. Whenever possible, we provide the brochures in English and Spanish. We may be able to secure information in another language if you require it. If this is the case, please email us at oklppp@health.ok.gov or call us at (405) 271-6617 or (800) 766-2223. Below are some brochures that we hope you will find beneficial to share with your patients.
For patients
For provider use
When do I use the Lead Exposure Risk Assessment Questionnaire (LERAQ)?
The Lead Exposure Risk Assessment Questionnaire (LERAQ) was developed for use to help you identify if there are other times that a child should be tested for lead besides the mandatory blood lead test at 12 months and 24 months. The questions are designed to help identify possible lead exposure. The LERAQ is not a substitute for doing the required blood lead testing and does not count as a blood lead screening for EPSDT or Head Start enrollment requirements.
