Revisions to DOH Blood Lead Testing Recommendations

| January 26, 2026

01/26/2026

The Washington State Department of Health (DOH) has revised the state’s blood lead action level to 3.5 µg/dL, to be more protective of children’s health and prevent further exposure. DOH recommends that health care providers begin blood lead confirmatory and follow-up testing at 3.5 µg/dL.  

The Notifiable Conditions rule, which requires all blood lead tests to be reported to DOH, will not be changing at this time. Reporting requirements will remain the same – within 2 business days for results ≥5 µg/dL, and within 30 days for all other results. 

Current Situation in Washington

Washington State’s blood lead testing rate is very low. Less than 10% of children under age six were tested in 2024. Additionally, the state is not meeting the Medicaid mandate, which requires providers to complete blood lead testing of all Medicaid-enrolled children at 12 and 24 months, or at least once before 72 months when no evidence of a prior test exists. 

Lead is a neurotoxin and even at low levels, exposure is particularly harmful to children. Blood lead testing is the only way to identify children who have been exposed to lead. Increasing testing rates will enable DOH and partners to identify children exposed to lead and take action to prevent further exposure and mitigate any health impacts. It will also allow DOH to assess the risk of lead exposure throughout the state.

Actions Requested:  

  • Review lead exposure risk factors with parents/caregivers of children under age six.If any risk factors are indicated or unknown, complete a blood lead test. 
  • For children under six enrolled in Medicaid, conduct blood lead tests at twelve and twenty-four months of age, or at least once before seventy-two months if no record of a prior test exists. 
  • If the child’s initial test is a capillary over 3.5 µg/dL or above, schedule or complete confirmatory testing. If possible, confirmatory testing should be done with a venous lead test. If this is not feasible, a second capillary result is acceptable when proper care is taken to clean the finger. See the CDC’s Mission Unleaded video for more information.  
  • Depending on lead test result, schedule follow-up testing and assess lead risk factors at future well-child visits.  
  • Follow the Pediatric Environmental Health Specialty Unit’s (PEHSU) clinical guidance found in Recommendations on Management of Childhood Lead Exposure.  
  • For any blood lead test result, provide the family with guidance on potential sources of lead and steps to prevent further exposure. This could include sharing DOH publications on lead with the family.
  • Report all blood lead test results to DOH – results ≥5 µg/dL reported within 2 business days, and all other results within 30 days.  

Background

In October 2021, the federal Centers for Disease Control (CDC) revised the blood lead reference value to 3.5 µg/dL, a lead level higher than 97.5% of U.S. children. There is no known safe level of lead, and lead exposure can be especially harmful to children during key stages of neurological development. 

Resources  

To learn more: doh.wa.gov/lead  

For all questions regarding reporting test results, please contact lead@doh.wa.gov.

Contact

For any questions, please contact:

Yakima Health District

(509) 249-6541