Universal Child Testing

Universal Child Lead Testing needed to expand child lead testing.

Background: Millions of American children missing early lead tests, Reuters finds.

Two problems in Ohio

Too many children who are at risk of lead poisoning are not being tested when they are most vulnerable (universal testing).
To avoid expanding the number of number of inspections of children who test positive for lead exposure, in 2023 Ohio redefined "lead poisoning." Ohio is not in compliance with CDC Action levels.

Here are the details.

For decades Ohio's rules for Child Lead Testing have been built around an antiquated system of 'high risk zip codes'. This system has four flaws

1. The "high risk zip codes have been determined by the number of reports of children with elevated blood lead levels. Ohio only requires testing where testing was previously encountered. We know that environmental lead is found in homes, soil, and water systems as well as near industrial sources.

2. Using the MD screening protocol takes time away from patient care. CLASH recommends, test them all.

3. There's anecdotal evidence that health care providers are exercising personal discretion in the use of the screening protocols. Two quick examples: Better Health Partnership reports that providers are more likely to test children in the Hough neighborhood than children in Shaker Heights...even though each neighborhood is in the same zip code. We also know that only about half of the children on Medicaid are tested...even though it is a mandatory requirement. Solution to discretion: Test them all.

4. Ohio Guidance requires testing at age 1 and age 2...or before age 6 if a child has not been tested before. This protocol ignores the fact that children can be exposed to lead when the child moves to a new location or changes child care locations between the ages of 3-6.

In 2023, Ohio Health Department amended the Ohio Administrative Code to create a brand new status of "Elevated Blood Lead Level" for children under age 6 who have a blood lead level of 3.5 micrograms/deciliter to under 10 micrograms/declilter. Rule 3701-30-07 | Public health lead investigations provides that local health departments are not required to conduct a lead risk assessment for children unless they have been determined to have a blood level on 10 microgram/deciliter or greater AKA "lead poisoned" This rule undermines the CDC reference standard of 3.5 micrograms/deciliter.

Among the "lead belt" states, Michigan, Indiana, Wisconsin and the city of Pittsburgh have adopted forms of universal child lead testing or lower thresholds of action. In each case there are additional testing requirements for high risk factors including age of housing and frequency of testing.

Goals

A working group recruits a member of the Ohio General Assembly to sponsor of the legislation directing the Ohio Department of Health amend sections Rule 3701-30-01 and Rule 3701-30-07 so that all children under the age of 6 be tested for lead poisoning and that any child with a confirmed lead level greater than 3.5 mg/dl be referred to a local health department to conduct a lead risk assessment of the child's home or frequently visited locations to identify the source of the lead hazard.
Each Organizational member of the working group supports the passage of the draft law in the State General Assembly or with the Governor of the state of Ohio to issue an executive order to the Director of Health.

Potential Team members

BCDI-O

Better Housing Partners

COHHIO

Ohio Housing Law Project

Ohio Healthy Homes Network

Ohio Lead Free Kids Coalition

NOBLE Northern Ohioans for Budget Legislation Equality (NOBLE) is endorsing Universal Child Testing in the General Assembly.

Fair Shake

Medical groups

Universal Testing in the News

January 28, 2025. Milwaukee Journal Sentinel. Tony Evers announces lower threshold for lead poisoning as part of children's health focus "Gov. Tony Evers announced a new rule Tuesday that lowers the lead poisoning threshold in Wisconsin. "The new rule will lower the threshold from 5 micrograms per deciliter to 3.5 micrograms per deciliter, according to a press release, and put the number more in line with the Centers for Disease Control and Prevention's recommendations. The lower threshold is intended to identify more children with lead poisoning and expose them to services. The rule is the latest attempt from Evers' administration to address lead poisoning across Wisconsin, but especially in Milwaukee, where children have to be checked often for exposure to lead."
January 18, 2024 Press release. DHS Recommends Blood Lead Tests for All Children. "Tests now encouraged for children ages 1 and 2, and those aged 3-5 who have not been previously tested. The Wisconsin Department of Health Services (DHS) recommends universal blood lead testing for children living in Wisconsin. Universal testing means all children should receive a blood lead test at ages 1 and 2 as well as any child between ages 3 and 5 who has not had a previous test. Children under 6 residing in the city of Milwaukee require additional testing per local health department guidelines."
Related: October 23, 2024. Press Release. MHD Issues New Testing Recommendations to Protect Children. "New Testing Recommendations: [Milwaukee Health Department] MHD has updated its testing guidelines to better safeguard children in the city. Previously, MHD did not recommend universal testing annually after 24 months unless a child tested positive for elevated blood lead levels. However, due to Milwaukee’s large population, the high prevalence of lead paint and other lead hazards, and the deterioration of older homes, MHD is now adopting a more aggressive testing schedule than both its previous recommendations and the state’s current guidelines. MHD’s new recommendations call for universal blood lead testing for all children in Milwaukee at 12, 18, and 24 months, and then annually through the age of 5, regardless of their previous testing schedule or results. This approach provides earlier detection and more frequent monitoring in areas at high risk for lead exposure."
October 3, 2023. Detroit Free Press. Universal lead testing requirement landmark moment for Michigan, advocates say
June 9, 2016. Reuters. Millions of American children missing early lead tests, Reuters finds.

Wait there's more

Ohio law requires all healthcare providers to administer blood lead tests to children at age 1 and 2, or up to age 6 if no previous test has been completed based on the following criteria: the child is on Medicaid, lives in a high-risk ZIP code, or has certain other risk factors.

Here's are the problems with the ZIP code system.

Ohio established the high-risk Zip Code system decades ago based on past experience of medical professionals. These "high risk" zip codes reflect where lead hazards exist. Sebring
Neither ODH nor Ohio Medicaid Services monitor or incentivize health care providers to improve the rate child lead testing. A recent effort at Akron General Hospital shows improvements is child lead testing can be made at the point of care.
A recent study in reported in Medscape that confusing rules about who should be tested present a barrier to overworked pediatricians.
This is not just an Ohio Problem, but other states have addressed it by enacting universal child testing.

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