Of 20,000 tests last year of blood-lead levels in children 6 and younger, fewer than 2 percent were high enough to warrant concern, state health officials say. But parents and health providers should pay close attention to real risks. Hint: It’s not the water.

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Amid renewed questions about lead in local drinking water, Washington health officials say 365 young children in the state posted blood-lead levels last year high enough to potentially cause harm.

But they caution that’s just a fraction of the 20,000 tests of kids ages 6 and younger submitted to the state Department of Health in 2015. The majority showed no sign of trouble.

Overall, the state’s risk is so low, the agency that oversees Medicaid has requested a waiver from federal rules requiring lead screening for all toddlers ages 1 and 2 covered by the program.

Risk factors for lead poisoning

• Home built before 1950

• Home built before 1978 but recently renovated

• Very low income: 130 percent of the federal poverty level

• Sibling or playmate with elevated blood-lead level

• Recent immigrant, refugee or child in foster care

• Parent or caregiver whose job involves lead exposure

• Use traditional folk or ethnic remedies or cosmetics

Source: Washington State Department of Health

“We want to screen the right kids,” said Lauren Jenks, director of the health department’s office of environmental-health sciences.

The key, said Jenks and other officials, is to target screening to those likely exposed to the most potent sources of lead, which can cause irreversible mental and physical damage, especially in young children.

Don’t think drinking water. Think lead paint in old houses, lead tracked home from a parent’s job and lead from other sources, including soil, hobbies or cultural practices.

“In the big picture of the risk of health problems from lead, water is not high,” said Dr. Jeff Duchin, health officer for Public Health — Seattle & King County.

His comments come amid a flurry of interest in lead in local drinking water long after the crisis was revealed in Flint, Mich.

In recent days, water-utility managers in Tacoma announced elevated lead levels at a few homes and Tacoma Public Schools revealed the results of tests — some conducted as long as a year ago — that showed high levels at more than a dozen elementary schools.

After the early reports out of Tacoma, Seattle Public Utilities officials announced water testing in five Seattle homes and declared in a statement Wednesday, “The city’s water remains safe to drink.”

All results of blood-lead tests in children must be reported to the state, health officials said. Of the estimated 20,000 tests conducted in 2015, only 365, under 2 percent, reported that children had levels of lead equal to or greater than 5 micrograms per deciliter of blood. That’s the level the Centers for Disease Control and Prevention (CDC) uses to identify children with blood-lead levels much higher than those of most kids in the country.

Many counties in Washington reported a dozen or fewer cases of elevated lead levels last year; 10 counties reported fewer than 10 cases, state data show.

King County had the highest number of cases, 132, likely because it’s the most populous county in the state and because more children with high lead levels — those involved in international adoptions, for instance — are likely to be tested there, Jenks noted.

Of those, only about 26 were above 10 micrograms of lead per deciliter of blood, high enough to warrant an in-home visit, said Nicole Thomsen, a public environmental-health planner with the county.

“We triage our cases here in King County on a three-step process, with an increasing level of response as the blood level increases,” she said.

The highest blood-lead level reported in King County last year was in a child older than 6 who posted 35 micrograms of lead per deciliter, raising serious concerns.

Health officials never confirmed the source in that case, Thomsen said.

Medical treatment is indicated for children with levels at 45 micrograms of lead per deciliter of blood, the CDC advises. But lead can cause central-nervous-system problems and diminished IQ at much lower levels.

Typically, the primary source of lead poisoning is lead-based paint in homes built before 1950 or built before 1978 and recently remodeled. Other sources include occupational exposures — when a parent tracks home lead from a construction job, for instance — and cultural exposures, including sources such as spices or cosmetics. Imported products, including toys and pottery, can be another source.

“If parents are concerned about lead exposure, they should talk to a doctor about getting a blood-lead test,” Jenks said.

Blood-lead levels nationwide have fallen sharply since the 1970s, with the advent of unleaded gasoline and bans on lead-based paint, according to the CDC. In 1976, an estimated 88 percent of children in the U.S. ages 1 to 5 had elevated blood-lead levels according to the standard of the time.

Nationwide, about half a million children, or about 2.6 percent, now have high blood-lead levels. It’s about 2.2 percent in this state.

In 2012, the Centers for Medicare and Medicaid Services (CMS) revised a policy that required lead screening for all children ages 1 and 2 enrolled in the federal program. Citing CDC recommendations, the agency said that low income alone was no longer an indicator for lead screening, but should be considered along with other factors.

The centers agreed to allow states to request waivers to the rule, as long as they could provide evidence that a targeted lead-screening approach would work. Washington officials submitted a detailed report requesting a waiver last November. Several other states have draft plans pending.

“It doesn’t make sense to screen every child,” said MaryAnne Lindeblad, Medicaid director for the Washington Health Care Authority. “The evidence is just not there.”

Agency officials are still waiting for an answer. If the waiver is approved, children aged 12 to 24 months will no longer get automatic finger-sticks for blood-lead tests. Instead, health-care providers will request blood tests when indicated or when a parent requests it, Lindeblad said.

The key now will be ensuring that all children actually at risk for lead poisoning get tested, Duchin said. That means parents and health-care providers need to pay attention to the real potential for danger.

“It’s certainly not from the water,” he said. “We have no reason to think there’s a public-health concern there.”