Lead screening for children happens at regular checkups: the doctor asks a few questions about lead risks, and many children also get a small blood test at 1 and 2 years old. Children on Medicaid must have that blood test at 12 and 24 months, and a growing number of states now require it for every child.
In short: the American Academy of Pediatrics (AAP) schedule calls for a lead risk assessment at the 6, 9, 12, 18 and 24 month visits and every year from age 3 to 6. Federal Medicaid rules require blood lead tests at 12 and 24 months, plus a test between 24 and 72 months for any child never tested, and a questionnaire alone does not count. States such as Illinois, Michigan, New York and Massachusetts require blood tests for all young children. The test is usually a finger or heel stick. Ask your pediatrician, your local health department or your WIC office which tests your child is due for.
This guide summarizes official guidance and is not medical advice. If you think your child swallowed something with lead in it, call Poison Control at 1-800-222-1222, and call 911 for severe symptoms.
Why children are screened even when they seem healthy
Most children with lead in their blood have no obvious symptoms, and the CDC says all children at risk for lead exposure should be tested. The CDC says children younger than 6 are more likely to be exposed because of their hand-to-mouth behavior. Our lead and children guide explains why young children are most at risk, and lead poisoning symptoms covers the signs that can appear.
“Screening” covers two different things:
- Risk assessment: a short set of questions the doctor or nurse asks you about your home, family and habits. No needle involved.
- Blood lead test: a small blood sample that measures lead in micrograms per deciliter (µg/dL). This is the only way to know your child’s actual level. See blood lead test for how results are read.
The lead screening schedule at a glance
Federal Medicaid rules, the AAP schedule and CDC guidance; states can add tests.
| Age | What’s recommended | Source |
|---|---|---|
| 6 months | Lead risk assessment (questions) at the well-child visit | AAP Bright Futures |
| 9 months | Risk assessment; in Massachusetts, a blood test once between 9 and 12 months | AAP; Massachusetts DPH |
| 12 months (1 year) | Risk assessment; blood lead test required for children on Medicaid or CHIP-funded Medicaid; blood test for all children in states with universal testing | AAP; CMS (EPSDT); state health departments |
| 18 months | Risk assessment | AAP Bright Futures |
| 24 months (2 years) | Risk assessment; second blood lead test required for Medicaid; blood test in universal-testing states | AAP; CMS (EPSDT); state health departments |
| 2 to 6 years (24 to 72 months) | Risk assessment every year at 3, 4, 5 and 6; blood test for any Medicaid child with no record of a previous test; extra tests in some states (for example ages 3 and 4 in Massachusetts) | AAP; CMS; state health departments |
| Newly arrived refugee children (up to 16) | Blood test at the domestic medical exam; children 6 and under get a repeat test 3 to 6 months later | CDC refugee health guidance |
Medicaid and CHIP: tests at 12 and 24 months
Medicaid’s EPSDT (Early and Periodic Screening, Diagnostic and Treatment) benefit sets the clearest rule. The Centers for Medicare & Medicaid Services (CMS) says all children enrolled in Medicaid, whether coverage is funded through title XIX (Medicaid) or title XXI (CHIP), are required to receive blood lead screening tests at 12 months and 24 months. Any child between 24 and 72 months with no record of a previous blood lead test must also receive one.
Two details from CMS guidance:
- Filling out a risk questionnaire does not meet the Medicaid requirement. The blood test itself has to be done.
- Medicaid pays for point-of-care blood lead tests done in the doctor’s office, so many families get the result during the same visit.
The AAP Bright Futures schedule for every child
For children not on Medicaid, pediatricians usually follow the AAP’s Bright Futures periodicity schedule. The AAP says it recommends a lead risk assessment at the 6, 9, 12, 18 and 24 month well-child visits and at 3, 4, 5 and 6 years. A blood lead test follows when the risk assessment is positive or when parents are concerned. The AAP also notes that Medicaid programs in many states require a universal blood test at the 12 and 24 month visits.
The CDC names higher-risk groups, including children who live in or spend time in buildings built before 1978, children in low-income households, and immigrant, refugee and recently adopted children. You can always ask for a test.
States that test every child
Many states go further. Examples from state health departments:
- Illinois: universal testing took effect July 1, 2026. The Illinois Department of Public Health says all Illinois children are to be tested automatically at 12 and 24 months, and all children 6 and younger are to be assessed for lead exposure with a questionnaire from their health care provider. Before that date, the automatic tests applied only in high-risk ZIP codes.
- Michigan: under a 2023 law and rules made final in 2025, physicians are to test, or order a test for, all children at 12 and 24 months, with a test between 24 and 72 months if there is no record of earlier tests. Families may opt out of universal testing.
- New York: the state health department says to get children blood lead tested at age 1 and again at age 2, and that providers should assess children from 6 months to 6 years for lead risk at every well-child visit.
- Massachusetts: the state requires a blood lead test at least once between 9 and 12 months, again at age 2 and age 3, and at age 4 in communities the state designates as high risk. Children need proof of a lead test to enter child care, preschool or kindergarten.
Rules change, and other states have their own schedules. Your pediatrician or your state or local health department can tell you what applies to your child.
The lead screening questionnaire
The risk assessment is a handful of yes-or-no questions. There is no single national form; states and clinics use their own versions built on CDC guidance. As one example, the South Dakota Department of Health asks:
- “Does the child live in or regularly spend time in a home built before 1978?” (It notes this is especially important with chipping or peeling paint or a renovation in the past year.)
- “Does the child live with a parent or caregiver who works in an occupation with frequent lead exposure?”
- “Does the child have a sibling or playmate with a blood lead level of 3.5 µg/dL or higher?” Or has a parent or caregiver asked for a lead test out of concern?
- “Has the child recently arrived in the U.S. as an immigrant, refugee, or foreign adoptee?”
If the answer to any question is “yes” or “I don’t know,” South Dakota advises talking with your child’s health care provider about a blood lead test.
Before the visit, find out when your home and child care setting were built, and think about recent paint work, jobs and hobbies, and imported spices, remedies, dishes, toys or jewelry (see lead in toys and jewelry).
What happens at the test
The CDC describes two ways to take the sample:
- Capillary test (finger-prick or heel-prick): usually the first step. A few drops of blood are collected, and results can come quickly, sometimes during the visit. Lead on the skin can get into the sample and make the result read higher than it really is.
- Venous test (blood draw from a vein): results take a few days from a lab. It is used to confirm a capillary result at or above the CDC’s blood lead reference value of 3.5 µg/dL.
A high finger-stick number is not a diagnosis on its own. The doctor will usually order a venous test to confirm it, and the timing of that test depends on how high the first result was. What the numbers mean and the CDC’s follow-up steps are explained in blood lead levels and lead poisoning test.
Refugee, immigrant and internationally adopted children
Children from other countries may have been exposed before arriving. For refugees, CDC guidance for the domestic medical exam (done within 90 days of arrival) says:
- All refugee infants and children up to 16 years old should get a blood lead test.
- Children 6 and younger should get a repeat test whatever the first result was; if it was below 3.5 µg/dL, within 3 to 6 months after the first screening.
- Older children with an elevated first result, or with risk factors such as a sibling with an elevated level, may need follow-up testing too.
- Newly arrived pregnant or breastfeeding women and girls should also be screened.
Where to get your child tested, and what it costs
- Your child’s doctor or clinic. The usual place, often at the 1 and 2 year checkups.
- Your local health department. The CDC says health care providers and most local health departments can test for lead in blood.
- WIC. If your family uses WIC, ask your WIC office whether it offers lead testing or can refer you to a place that does.
Cost: the CDC says Medicaid covers testing for enrolled children and many private insurance plans cover it. Without coverage, prices are not standardized, so we don’t list them; ask your local health department about options.
What you can do while you wait
You can start looking for lead around your child now. These steps from the CDC and EPA don’t replace testing:
- If your home was built before 1978, look for peeling or chipping paint, especially on windows, doors and porches, and keep children away from it. Our lead paint testing guide explains your options.
- Wet-mop floors and wipe windowsills, wash hands and toys often, and take shoes off at the door.
- Use cold tap water for drinking, cooking and baby formula.
- Check toys, jewelry, spices and dishes against FDA and CPSC recalls.
More in lead poisoning causes and prevention and the lead poisoning hub.
Frequently asked questions
At what age should my child have a lead test?
Blood tests are due at 12 and 24 months for children on Medicaid and in universal-testing states, with a catch-up test by age 6 if missed. The AAP adds risk questions at every well-child visit from 6 months to 6 years.
Does my 1 year old need a lead test?
On Medicaid or in a universal-testing state, yes: the first blood test is due at 12 months. Otherwise the doctor asks risk questions and recommends a test if there is risk or if you ask.
My child was tested at 1. Do they need another test at 2?
Under Medicaid rules and in states such as Illinois, Michigan and New York, yes. A result below the reference value at 12 months does not rule out exposure later.
Is the lead screening questionnaire enough?
Not for children on Medicaid: CMS says a risk questionnaire does not meet the requirement, and the blood test must be done. For other children, the questionnaire helps the doctor decide whether a blood test is needed. Only a blood test shows your child’s actual level.
Can I test my child for lead at home?
No. Only a blood test through a doctor, health department or lab measures lead in a child. Home kits test surfaces or water, which can help find a source.