The Consequences of Missing Children With Elevated Blood Lead Levels

For at least 20 years, the majority of California children with elevated blood lead levels have grown up unaware of this burden. In 1998, the California auditor estimated that targeted screening policies identified only 10% of the estimated 40 000 children with blood lead levels requiring medical care.¹ In our 2017 study, we estimated that the state’s screening policies result in the discovery of only 37% of children with elevated blood lead levels.² More than half of the California children at highest risk—those enrolled in Medicaid—did not receive a blood test.³ In an effort to improve lead screening rates, state legislators introduced a bill that would require lead testing for all children.⁴ To better understand the impact of universal screening, the legislature requested an analysis by the California Health Benefits Review Program.⁵

The authors of the California Health Benefits Review Program analysis concluded that there is little evidence to support universal blood lead screening, even though they estimated that the policy would lead to the discovery of an additional 4777 children with elevated blood lead levels.⁵ In their analysis, they used the lack of research on universal screening and the opposition to universal screening by “prominent medical professional groups” to determine that this policy is not warranted. They did not consider three consequences of continuing policies that consistently fail to identify children with elevated blood lead levels.

First, the extent of the harm caused by lead exposure will not be understood until all children with elevated blood lead levels are identified. Those formulating strategic plans to end childhood lead poisoning cannot expect to accomplish this goal without knowing how many children they need to reach. Second, not knowing which children have elevated blood lead levels prevents public health officials from identifying the leaded environments that poison children. Those places where children with elevated blood lead levels are exposed through environmental sources will continue to expose younger siblings and other children who inhabit these environments next. Third, children with elevated blood lead levels grow up unaware of their increased risk of cognitive delays and behavioral problems. The teachers and administrators working with these children often do not know that they should provide them with special educational support to mitigate the harms resulting from lead.

Targeted lead screening policies that miss children with elevated blood lead levels result in underreporting of the harm caused by lead poisoning and dampen the urgency necessary for a stronger public health response. So long as public health continues to respond to the lead crisis with incomplete data and defaults to the view of medical professional groups that comprehensive testing is not warranted, the crisis will continue.