Pediatric care guidelines recommend assessment of children for lead exposure during routine child care in the first two years of life. In Washington State, pediatric lead screening rates are among the lowest in the nation. This investigation sought to describe pediatric lead screening practices and barriers in King County, WA. King County providers were invited to complete a web-based survey regarding their lead screening practices between October 2018 and April 2019. Follow up semi-structured interviews (SSI) were conducted with 13 volunteer respondents. Respondents were characterized as high versus low screeners based on responses. Reported knowledge, practice, and barriers were compared for the two groups. Grounded theory methodology was used to identify provider attitudes and practices from SSIs. 246 providers who saw patients under the age of 6 years participated in the survey. Sixty six percent agreed or strongly agreed with the statement “Primary care for all children aged 12 to 24 months in King County should include a lead exposure history,” while only 39% reported always conducting a lead exposure history at least once during early childhood visits. Lower frequency screeners were more likely to report uncertainty about when to perform an exposure history and when to order a blood lead test. They were also more likely to report lack of a clinic system or policy to prompt them to conduct an exposure history. SSIs revealed a large variety in practices and barriers between clinics, suggesting that it will require a number of strategies to increase lead screening rates in King County. Strategies to improve lead screening rates in this community should include provider education on recommended screening practice, promoting standardized clinic policies, and working to partner with other early childhood development initiatives to promote lead screening, such as building collaborations with Early Head Start programs.