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 (capillary) or arm (venous). The test measures how much lead is in your child's blood. A venous sample is more accurate.

The only way to know if your child has been exposed to lead is to have them tested.

When should children be tested for lead?

Children must be tested:

  • At least once between 9-12 months
  • Again at age 2
  • Again at age 3
  • At age 4 if living in a high-risk community

Children must have proof of at least 1 lead test before entering childcare, preschool, or kindergarten.

Where can I go to have my child tested?

Your child's healthcare provider should order a lead test for your child. The blood sample may be taken during a provider’s visit, or you may be given a lab slip to take the child to an outside lab for a blood draw.

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. In 2021, the Centers for Disease Control (CDC) lowered its reference level from 5 µg/dL to 3.5 µg/dL. This identifies children with blood level levels that are higher than most children’s levels.

If your child has a blood lead level above 3.5 µg/dL from a capillary (finger) test, CDC recommends that your child should be tested again to confirm the result. A second test should be done with a venous sample and follow the schedule below:

Capillary Blood Lead Level (μg/dL)

Confirmation Test Due

3.5-4.9

3 months*

5-9

3 months**

10-14

1 month**

15-19

2 weeks**

20-44

1 week**

45 - 69

48 hours**

≥ 70

Seek emergency medical care

*CDC’s recommended confirmation test schedule.

**The higher the blood lead level on the initial capillary screening, the more urgent the need for a confirmatory test.

If your child has a blood lead level (BLL) above 3.5 µg/dL from a venous test (arm), your child should be re-tested routinely until the child’s BLL is under 3.5 µg/dL. The schedule below should be followed:

Venous Blood Lead Levels (µg/dL)

Follow-up Testing

3.5-4.9

6-9 months*

5-9

3-6 months**

10-14

2-3 months**

15-19

1-2 months**

20-44

2 weeks- 1 month**

45-69

Provider's discretion

≥ 70 µg/dL

Provider's discretion

* CDC’s recommended follow-up testing schedule.

** Some healthcare providers may choose to repeat blood lead tests sooner to ensure your child’s blood lead level is not increasing.

Venous Blood Lead Levels and Follow Up Actions

Blood Lead Level

Health Care Provider Follow Up

Environmental Actions

Case Management

Re-screening Schedule

0-3.4 µg/dL

Monitor for annual re-screen and high-risk factors  

Preventative inspection for    pre-1978 homes

  • 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.

3.5-4.9 µg/dL

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

Preventative inspection for    pre-1978 homes

  • 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 6-9 months (CDC guidance)

5-9 µg/dL Blood lead level of concern. Check for iron deficiency. Iron therapy if needed. Provide Lead Education to family. Nutritional Counseling related to Calcium and Iron. Complete a lead risk assessment.

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.

CLPPP lead inspector assigned for mandatory environmental investigation. If lead hazards are found in the home, it 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.

CLPPP lead inspector assigned for mandatory environmental investigation. If lead hazards are found in the home, it home must be deleaded.

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

Check BLL within 1-2 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.

CLPPP lead inspector assigned for urgent mandatory environmental investigation. If lead hazards are found in the home, it must be deleaded.

CLPPP Client Care staff 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. Client Care staff will inform the clinician and specialty clinic on environmental status for chelation decisions.  If lead hazards are found in the home, it 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, typically sooner. Client Care staff will inform the clinician and specialty clinic on environmental status for chelation decisions.  If lead hazards found in the home, it 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.

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.

Pediatric Environmental Specialist Clinics

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