Lead, Anemia and Other Screenings at Checkups

Well-child visits include more than a quick listen to the heart and a growth check. At certain ages, your pediatrician also recommends specific screening tests. A screening test looks for a problem before your child has symptoms, when it is often easier to treat. Some screenings are a finger stick or a short questionnaire. Others use a simple device. This guide walks through the most common ones: newborn screening follow-up, lead, anemia, hearing, cholesterol and depression, and what happens if a result comes back abnormal.

Newborn screening follow-up

Every baby born in Texas has a blood test to check for a group of rare but serious conditions, including some that affect hormones, metabolism, blood and the immune system. According to the Texas Department of State Health Services, all babies are tested twice. The first test is done at the hospital a day or two after birth. The second is done at 7 to 14 days of age at your pediatrician's office or a clinic. A few drops of blood are taken from your baby's heel.

Babies also get a hearing screen and a check for certain heart problems before leaving the hospital.

What you can do:

• Make sure your baby gets the second newborn screen on time. Bring it up at your baby's first visit.
• If you are told a result needs to be repeated, go back quickly. Most repeat tests come back normal, but some conditions need treatment within days.
• If your baby did not pass the newborn hearing screen, finish the follow-up hearing test as soon as you are asked. Learn more about newborn screening on MedlinePlus.

Lead testing

Lead is a metal that can harm a child's growing brain, even at low levels, and most children with lead in their blood have no symptoms. The only way to know is a blood test. Common sources include peeling or chipped paint in homes built before 1978, dust and soil near older buildings, some imported spices, candies, pottery, traditional remedies and cosmetics, and jobs or hobbies that bring lead dust home on clothes.

Your pediatrician asks questions about lead risk at early checkups. In Texas, the state's lead program says that all children enrolled in Medicaid or Texas Health Steps must be tested at 12 and 24 months of age, or at any age after 12 months and up to 6 years if they were never tested. The state also recommends testing children who live in certain higher-risk zip codes or have other risks for lead exposure. See the Texas DSHS page on testing your child for lead for details.

The test is usually a finger stick or blood draw. If the level is raised, your pediatrician will repeat the test, help you find and remove the source, talk about diet, and follow your child over time. Foods rich in iron, calcium and vitamin C can help lower how much lead the body absorbs.

Anemia screening

Anemia means the blood has fewer healthy red blood cells than normal. In young children, the most common cause is not getting enough iron. Iron is important for brain development, energy and growth.

The AAP recommends checking hemoglobin, a measure of red blood cells, at about 12 months, often with a quick finger stick. At other visits, your pediatrician asks questions to see whether your child may be at risk, and tests if needed. Higher-risk children include:

• Babies born early or at a low birth weight
• Toddlers who drink a lot of cow's milk, which can crowd out iron-rich foods
• Children with limited diets or very picky eating
• Teen girls with heavy periods
• Teens who follow a vegetarian or restricted diet, or who are athletes

If your child has anemia, your pediatrician may suggest changes to diet and may prescribe iron. Do not give iron supplements without talking to your pediatrician first. Iron is one of the most dangerous things for a child to swallow by accident. Keep all vitamins and iron pills locked up, and if your child swallows some, call Poison Control at 1-800-222-1222. Read more about anemia on MedlinePlus.

Hearing screening

After the newborn screen, hearing is checked at regular well visits. Younger children are asked questions about hearing and speech. Starting around age 4, many children have a hearing test with headphones and beeps, repeated at several ages through grade school and again in the teen years. Teens are also asked about loud music, earbuds and noise. Texas schools may screen hearing too.

Cholesterol screening

High cholesterol can start in childhood and often runs in families. The AAP recommends a cholesterol blood test for all children once between ages 9 and 11, and again between ages 17 and 21. Children with a strong family history of high cholesterol or early heart disease, or with conditions such as diabetes or obesity, may be tested earlier, sometimes starting at age 2. Let your pediatrician know if a parent, grandparent, aunt or uncle had a heart attack or stroke at a young age.

Depression and mental health screening

Starting at age 12, the AAP recommends yearly depression screening at checkups. Teens fill out a short questionnaire about mood, sleep, energy and feelings of hopelessness. The pediatrician also asks about anxiety, substance use, safety and relationships, often in private time with the teen. Parents are part of the conversation, but some private time helps teens speak openly. New moms may also be screened for postpartum depression at their baby's early visits, since a parent's mental health affects the whole family.

Other checks you may notice

Depending on age and risk, your child may also have blood pressure checks starting at age 3, questions about tuberculosis risk, autism and development screening in the toddler years, and screening for sexually transmitted infections or HIV in the teen years. The AAP's HealthyChildren.org page on lead exposure has more on protecting your family from lead.

When to call us

Call your A thru Z Pediatrics office if you missed your baby's second newborn screen, were asked to repeat a test, are not sure whether your child has had a lead test, notice that your child seems pale, tired or short of breath, or have concerns about your child's hearing, speech or mood.

Call 911 or go to the ER if your child swallows iron pills or other medicine and seems sick, has a seizure, or talks about suicide or hurting themselves.

To schedule a checkup with the screenings your child is due for, request a visit.