Learn about lead testing in Massachusetts and what a result means for your child

Every child in Massachusetts must be tested for lead. Learn more about when to have them tested and what your child’s blood lead level means.

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 samples can be taken in two ways:

  • From the finger. This is called a capillary sample
  • From the arm. This 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 5 µg/dL (micrograms per deciliter of blood), and the nurse took blood from your child's finger, you must have a second test with a venous sample as soon as you can, but not more than 2 months after the first test.

When should children 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. Click here to see the most recent high risk community list.

Every child must have a lead test before they begin daycare, Kindergarten, or preschool.

Where can I go to have my child tested?

Your child's healthcare provider 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 healthcare provider 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.

The test measures lead levels as µg/dL, or "micrograms per deciliter of blood."

There is no "safe" level of lead in the blood, but a small amount of lead can be found in most children’s because lead is in the environment. Most children have lead levels under 5 µg/dL. More information about specific blood lead level ranges can be found below.

0-<5 µg/dL

  • 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

5-<10 µg/dL

  • In 2012, the CDC created a reference level of 5 µg/dL 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
  • Learn more about the CDC’s level of concern
  • Your child needs to be tested again within 3-6 months
  • It is important to find and fix the lead hazards in your home. Have your home tested for lead.

10-<24 µg/dL

A child under 6 years old with a lead level greater than 10 µg/dL is lead poisoned.

  • Most children will not look or act sick
  • Your healthcare provider may give your child iron. Talk to your doctor about learning or development problems.
  • 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.
    • If your child's level is 10-14, 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.
  • Your child needs to be tested for lead a second time. Test your child again within 1 month, or sooner for very high levels. Talk with your healthcare provider.

Type of follow up by Blood Lead Level (BLL) for venous blood specimens

Blood Lead Level

Health Care Provider Follow Up

Environmental Actions

Case Management

Re-screening Schedule

0 - 4 µg/dL

BLL found in most children. No action at MA CLPPP.

Inspection upon parental request.

  • Families who rent can contact local Board of Heath.
  • Families who own can hire a privately licensed lead inspector.

 

Re-screen child annually through age 3. If the child lives in a high-risk community, screen again at age 4.

5 - 9 µg/dL

Level of Concern. Check for iron deficiency. Iron therapy if needed. Provide Lead Education to family. Nutrition Counseling related to Calcium and Iron.  Complete a lead risk assessment to determine rescreening timeframe.

Inspection upon parental request.

  • Families who rent can contact local Board of Heath.
  • Families who own can hire a privately licensed lead inspector.

Referral to Community Health Worker and Care Coordination upon doctor request.

Check BLL between 3-6 months. Siblings <6 years of age should be tested.

10-14

µg/dL

Lead Poisoned. Cases ≥ 10 µg/dL are considered poisoned. Check for iron deficiency. Iron therapy if needed.

Inspector assigned for environmental investigation. If the inspector identifies lead hazards in the child’s home, the home must be deleaded.

Community health worker services offered to family. CLPPP Care Coordinator assigned. Re-screening compliance monitored, with re-test reminder letters mailed.

Check BLL within 3 months. Siblings <6 years of age should be tested.

15 - 19 µg/dL

Lead Poisoned. Check for iron deficiency. Iron therapy if needed.

Inspector assigned for environmental investigation. If the inspector identifies lead hazards in the child’s home, the home must be deleaded.

Community health worker services offered to family. CLPPP Care Coordinator assigned. Re-screening compliance monitored, with re-test reminder letters mailed.

Check BLL within 2 months. Siblings <6 years of age should be tested.

20 - 44 µg/dL

Lead Poisoned. Check for iron deficiency. Iron therapy if needed. Abdominal x-ray with bowel decontamination if indicated. Consultation with a Pediatric Environmental Health Specialist to consider Chelation at 35-44 µg/dL.

Inspector assigned for urgent environmental investigation. If the inspector identifies lead hazards in the child’s home, the home must be deleaded.

Community health worker services offered to family. CLPPP Care Coordinator assigned or CLPPP Public Health Nurse assigned. Re-screening compliance monitored, with re-test reminder letters mailed.

Check BLL within 1 month. Siblings <6 years of age should be tested.

45 - 69 µg/dL

Lead Poisoned. Medical evaluation (most children are hospitalized). Abdominal x-Ray with bowel decontamination if indicated. Consultation with a Pediatric Environmental Health Specialist. Chelation therapy. Consider extending hospitalization if lead-safe environment cannot be assured.

Emergency Inspection. Site visit with assessment and counseling will happen within 2-3 days, typically sooner. Nurse Case Manager will inform the clinician and specialty clinic on environmental status for chelation decisions.  If lead hazards found in the home they must be deleaded.

Community health worker services offered to family. CLPPP Nurse Case Manager assigned. Re-screening compliance monitored, with re-test reminder letters mailed.

Provider's discretion. Siblings <6 years of age should be tested. Other family members may also need to be tested depending on the source of the exposure.

≥ 70 µg/dL

Lead Poisoned. Immediate hospital admission and chelation therapy. Consultation with a Pediatric Environmental Health Specialist. Iron therapy after treatment.

Emergency Inspection. Site visit with assessment and counseling will happen within 24 hours. Nurse Case Manager will inform the clinician and specialty clinic on environmental status for chelation decisions. If lead hazards found in the home they must be deleaded.

Community health worker services offered to family. Retest Reminder letters mailed. CLPPP Nurse Case Manager assigned.

Provider's discretion. Sibling <6 years of age should be tested. Other family members may also need to be tested depending on the source of the exposure.

Type of follow up by Blood Lead Level (BLL) for capillary blood specimens

Blood Lead Level

Health Care Provider Follow Up

Environmental Actions

Case Management

Re-screening Schedule

0 - 4 µg/dL

BLL found in most children. No action at MA CLPPP.

Inspection upon parental request.

  • Families who rent can contact local Board of Heath.
  • Families who own can hire a privately licensed lead inspector.

 

Re-screen child annually through age 3. If the child lives in a high-risk community, screen again at age 4.

5 - 9 µg/dL

Level of Concern. Check for iron deficiency. Iron therapy if needed. Provide Lead Education to family. Nutrition Counseling related to Calcium and Iron.  Complete a lead risk assessment to determine rescreening timeframe.

 

 

Re-screen with a venipuncture within 12 weeks. Siblings <6 years of age should be tested.

10-14

 

Level of Concern. Check for iron deficiency. Iron therapy if needed. Provide Lead Education to family. Nutrition Counseling related to Calcium and Iron.  Complete a lead risk assessment to determine rescreening timeframe.

 

CLPPP Care Coordinator assigned. Re-screening compliance monitored, with re-test reminder letters mailed.

Re-screen with a venipuncture within 12 weeks. Siblings <6 years of age should be tested.

15 - 19 µg/dL

Level of Concern. Check for iron deficiency. Iron therapy if needed. Provide Lead Education to family. Nutrition Counseling related to Calcium and Iron.  Complete a lead risk assessment.

 

CLPPP Care Coordinator assigned. Re-screening compliance monitored, with re-test reminder letters mailed.

Re-screen with a venipuncture within 12 weeks. Siblings <6 years of age should be tested.

20 - 44 µg/dL

Level of Concern. Check for iron deficiency. Iron therapy if needed. Provide Lead Education to family. Nutrition Counseling related to Calcium and Iron.  Complete a lead risk assessment.

 

CLPPP Care Coordinator assigned. Re-screening compliance monitored, with re-test reminder letters mailed.

Re-screen with a venipuncture within 7 days. Siblings <6 years of age should be tested.

45 - 69 µg/dL

Level of Concern. Check for iron deficiency. Iron therapy if needed. Provide Lead Education to family. Nutrition Counseling related to Calcium and Iron.  Complete a lead risk assessment.

 

Nurse Case Manager assigned. Re-screening compliance monitored, with re-test reminder letters mailed.

Re-screen with a venipuncture within 48 hours. Siblings <6 years of age should be tested.

≥ 70 µg/dL

Level of Concern. Check for iron deficiency. Iron therapy if needed. Provide Lead Education to family. Nutrition Counseling related to Calcium and Iron.  Complete a lead risk assessment.

 

Nurse Case Manager assigned. Re-screening compliance monitored, with re-test reminder letters mailed.

Re-screen with a venipuncture as soon as possible. Sibling <6 years of age should be tested.

How is lead poisoning treated?

There are different types of medical treatment for lead poisoning. 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 improved. Making sure your home is free from lead hazards is critical to make sure your child does not get re-exposed.

For more information, call the Childhood Lead Poisoning Prevention Program (CLPPP).

Additional Resources for How is lead poisoning treated?

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