Common Questions About Blood Lead Testing and Treatment
What is a lead test?
In a lead test, a blood sample is taken from the child's finger or arm. The test measures how much lead is in your child's blood. Blood taken from the finger is called a capillary sample. Blood taken from the arm is called a venous sample. A venous sample is more exact. Ask your doctor to test your child for lead. If your child has a lead level above 10 and the nurse took blood from your child's finger, you should have a second test with a venous sample.
When should children be tested for lead?
Every child in Massachusetts must be tested for lead. The first test must be done between the ages of 9 and 12 months. Children must be tested again at ages 2 and 3. If you live in a high risk neighborhood, your child must also be tested at age 4 (see "Lead research and statistics" for a list of high risk communities). Every child must have a lead test before they begin Kindergarten.
Where can I go to have my child tested?
Your child's doctor should test your child at ages 9-12 months, and ages 2 and 3. If your child has not had a lead test, ask the doctor to test your child. You can also contact a local health clinic for a lead test.
What does my child's blood lead level mean?
A blood lead level tells you how much lead is in your child's body. There is no safe level of lead in the blood, but a small amount of lead can be found in most children’s blood due to the pervasiveness of lead in the environment. Most children have lead levels under 5 micrograms per deciliter of blood (µg/dL). More information about specific blood lead level ranges can be found below.
- According to the National Health and Nutrition Examination Survey (NHANES)’s blood lead distribution in children, 97.5% of children in the U.S. have a blood lead level between 0-<5 µg/dL.
- In 2012, the CDC updated its guidelines on blood lead levels in children. The earlier 10 µg/dL level of concern was replaced with a reference level of 5 µg/dL.
- A reference level of 5 µg/dL is now used to identify children with blood lead levels that are much higher than most children’s levels.
- This new level is based on the U.S. population of children ages 1-5 years who are in the highest 2.5% of children when tested for lead in their blood.
- Please click on this link for more information about CDC’s level of concern.
10-<24 µg/dL: a child under 6 years old with a lead level between 10 and 24 has an elevated blood lead level
- The Massachusetts Department of Public Health (MDPH) Childhood Lead Poisoning Prevention Program (CLPPP) defines an elevated level of lead in the blood at ≥ 10 µg/dL.
- Most children will not look or act sick.
- The doctor may give your child iron. Talk to your doctor about learning or development problems.
- It is important to find and fix the lead hazards in your home. Have your home tested for lead.
- Your child needs to be tested for lead a second time. If your child's level is 10-15, test your child again within 3 months. If the level is 15-19, test your child again within 2 months. If your child's lead level is 20-24, test your child again within 1 month.
≥25 µg/dL: a child under 6 years old with a lead level of 25 or more is lead poisoned.
- Your child may have to stay in the hospital. The doctor may give your child medicine to help get the lead out of their body. This is called "chelation."
- Some children may have trouble speaking, hearing, or paying attention. Ask your doctor about learning problems. You may need a special education plan for your child.
- If your child is lead poisoned, your home must be tested for lead. An inspector from CLPPP will check your home for lead. If there is lead in your home, it must be fixed.
- Your child needs to be tested for lead a second time. Test your child again within 1 month.
Type of Follow Up by Blood Lead Level (BLL) for Venous1 Blood Specimens
Blood Lead Level
Health Care Provider Follow Up
Environmental Follow Up
0 - 4 µg/dL
BLL found in most children. No action at MA CLPPP.
5 - 9 µg/dL
CDC reference level begins at 5 µg/dL2. Education provided upon parental request; otherwise no action.
10 - 14 µg/dL
Check for iron deficiency. Iron therapy if needed.
Community health worker services offered3. Inspection only by parental request.
Check BLL within 3 months.
15 - 19 µg/dL
Check for iron deficiency. Iron therapy if needed.
Community health worker services offered. Inspector assigned to offer environmental investigation. If lead hazards found, home must be deleaded.
Check BLL within 2 months.
20 - 44 µg/dL
Check for iron deficiency. Iron therapy if needed. Cases ≥ 25 µg/dL are considered poisoned. Chelation therapy at 35 - 44 µg/dL.
Community health worker services offered. Mandated inspection at ≥ 25 µg/dL. If lead hazards found, home must be deleaded.
Check BLL within 1 month.
45 - 69 µg/dL
Medical evaluation (most children are hospitalized). Chelation therapy.
Community health worker services offered. Emergency inspection. If lead hazards found, home must be deleaded.
≥ 70 µg/dL
Immediate hospital admission and chelation therapy. Iron therapy after treatment.
Community health worker and hospital social worker services offered. Emergency inspection. If lead hazards found, home must be deleaded.
1 This table only pertains to venous test results. Capillary results that are ≥ 10 µg/dL must be retested for confirmation. A venous retest is recommended as best medical practice. If you have any questions please call 1800-532-9571 or visit the Childhood Lead Poisoning Prevention Program's page at www.mass.gov/dph.
2 The CDC has updated its guidelines on blood lead levels in children. The earlier 10 µg/dL level of concern was replaced with a reference level of 5 µg/dL. For more information please visit http://www.cdc.gov/nceh/lead/ACCLPP/blood_lead_levels.htm
3 Community health worker services include: lead hazard reduction education and outreach, translation services, home visits, counseling, and referrals to other agencies such as Early Intervention and the Women, Infants and Children Program (WIC).
How is lead poisoning treated?
There are different types of medical treatment for lead poisoning (lead levels of 25 or more). The doctor may give your child iron or medicines that remove the lead from the blood. This is called "chelation." You may want to have your child treated by a doctor with special knowledge and experience in lead poisoning.
Follow-up care may last for many months. The doctor may tell you to change your child's diet and add more foods with iron and calcium. During and after treatment, the doctor will test your child again to see if the blood lead levels have changed.
For More Information, call the Childhood Lead Poisoning Prevention Program at (800) 532-9571.