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Clinical Summary

Lead Levels in Childhood and Pregnancy: Screening

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Population Asymptomatic children ages 1 to 5 years who are at increased risk Asymptomatic children ages 1 to 5 years who are at average risk Asymptomatic pregnant women
Recommendation No recommendation
Grade: I (Insufficient Evidence)
Do not screen for elevated blood lead levels.
Grade: D
Do not screen for elevated blood lead levels.
Grade: D
Risk Assessment Children younger than age 5 years are at greater risk for elevated blood lead levels and lead toxicity because of increased hand-to-mouth activity, increased lead absorption from the gastrointestinal tract, and the greater vulnerability of the developing central nervous system.

Risk factors for increased blood lead levels in children and adults include: minority race/ethnicity; urban residence; low income; low educational attainment; older (pre-1950) housing; recent or ongoing home renovation or remodeling; pica; use of ethnic remedies, certain cosmetics, and exposure to lead-glazed pottery; occupational exposure; and recent immigration.

Additional risk factors for pregnant women include alcohol use and smoking.

Screening Tests Venous sampling accurately detects elevated blood lead levels. Screening questionnaires may be of value in identifying children at risk for elevated blood lead levels, but should be tailored for and validated in specific communities for clinical use.
Interventions Treatment options for elevated blood lead levels include residential lead hazard-control efforts (i.e., counseling and education, dust or paint removal, and soil abatement), chelation, and nutritional interventions.

Community-based interventions for the prevention of lead exposure are likely to be more effective, and may be more cost-effective, than office-based screening, treatment, and counseling. Relocating children who do not yet have elevated blood lead levels but who live in settings with high lead exposure may be especially helpful.

Balance of Benefits and Harms There is not enough evidence to assess the balance between the potential benefits and harms of routine screening for elevated blood lead levels in children at increased risk. Given the significant potential harms of treatment and residential lead hazard abatement, and no evidence of treatment benefit, the harms of screening for elevated blood lead levels in children at average risk outweigh the benefits. Given the significant potential harms of treatment and residential lead hazard abatement, and no evidence of treatment benefit, the harms of screening for elevated blood lead levels in asymptomatic pregnant women outweigh the benefits.
Current as of: December 2006

Internet Citation: Clinical Summary: Lead Levels in Childhood and Pregnancy: Screening. U.S. Preventive Services Task Force. September 2016.
https://www.uspreventiveservicestaskforce.org/Page/Document/ClinicalSummaryFinal/lead-levels-in-childhood-and-pregnancy-screening

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