Now that gasoline is unleaded and lead is rare in paint, children are a lot less likely to be exposed to lead than in past decades. Still, the Centers for Disease Control and Prevention estimates that 2.2 percent of U.S. children have elevated blood levels of lead—high enough to damage their developing brains, sometimes causing learning disabilities, seizures, or even death. Since lead poisoning is less common now, the CDC recommends that states direct their screening efforts to children at higher risk of lead poisoning—and also says that an initial test finding a high level of lead must be confirmed with a follow-up test. Researchers in Michigan looked at children enrolled in Medicaid, who have a high risk of lead poisoning, to find out if they were getting that second test. If a second test does find a high level of blood, lead poisoning is handled by keeping children from having contact with the lead.

What the researchers wanted to know: Do doctors follow up on elevated lead levels in children?

What they did: In Michigan, all blood lead levels are reported to the state, whether they're high or low, which makes it easy to study blood lead levels there. The researchers looked at children enrolled in the Michigan Medicaid program, up to age 6, who had a blood test that found an elevated lead level in 2002 or the first half of 2003. Since they were interested in follow-up care, the researchers looked only at kids who were enrolled continuously in Medicaid for 180 days (about six months) after the test that found the lead. An elevated blood level is 10 micrograms per deciliter or higher.

What they found: Only 54 percent of the children had a follow-up test within six months of the first blood test showing an elevated level of lead in their blood. Minority and urban children are at higher risk of exposure, partly because they are more likely to live in older buildings with old paint, but they were less likely to get follow-up testing, as were Hispanic children and older children. Most of the kids who didn't get a follow-up test were receiving medical care. Indeed, 60 percent had at least one other "medical encounter" in the six months after their initial test.

What the study means to you: Follow-up testing is the starting point for managing an apparent lead-poisoning problem, the researchers say, but it appears that many children aren't getting even that first step. Given the dangers of lead poisoning, the researchers say it's vital to figure out why kids aren't getting the attention they need—and to figure out how to get them that care. In an accompanying editorial, a Cincinnati doctor calls these results "the tip of the iceberg," an example of how day-to-day medical practice doesn't necessarily take care of public health problems like lead poisoning and asthma. He said regulations should require that older housing be screened for lead before children move in and are exposed to lead instead of waiting until the child is poisoned and trying to clean up the lead after the damage has already been done.

Caveats: The researchers looked only at follow-up blood tests; they didn't find out if children were getting other interventions. (But they say follow-up testing is an essential first step.)

Find out more: Read information from the Environmental Protection Agency about protecting your child from lead exposure.

Read the article: Kemper, A.R. et al. "Follow-up Testing Among Children With Elevated Screening Blood Lead Levels." Journal of the American Medical Association. May 11, 2005, Vol. 293, No. 18, pp. 2232–2237.

Abstract online: http://jama.ama-assn.org