Pediatric Lead Toxicity Guidelines

Updated: May 16, 2022
  • Author: Mohamed K Badawy, MD, FAAP; Chief Editor: Stephen L Thornton, MD  more...
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Guidelines Summary

Guidelines and recommendations on screening for elevated blood levels (BLLs) are available from the following organizations:

  • American Academy of Pediatrics (AAP) [20]
  • Centers for Disease Control and Prevention (CDC) [22, 23]
  • United States Preventive Services Task Force (USPSTF) [24]

In 2012, the blood lead reference value (BLRV) for children corresponding to the 97.5 percentile was established at 5 micrograms per deciliter (µg/dL), on the basis of National Health and Nutrition Examination Survey (NHANES) data from 2007-2010. [22] In May 2021, the CDC revised its recommended reference value to 3.5 μg/dL following a reevaluation of NHANES data from 2015-2016 and 2017-2018 cycles. [25]

Prior to this current update, blood lead levels below 5 μg/dL may or may not have been reported to parents. The lower blood lead reference value of 3.5 μg/dL allows more children to be identified as having lead exposure and provides parents, physicians, public health officials, and communities an opportunity to intervene earlier to reduce the child’s future exposure to lead.

In 2019, the USPSTF concluded that evidence is insufficient to assess the balance of beneits and harms of screening for elevated blood lead levels in asymptomatic children younger than 5 years. [24]

The CDC guidelines require lead testing for the following children [22] :

  • At 12 and 24months for all Medicaid‐enrolled children, regardless of known lead‐exposure risk
  • Children < 72 months who missed the recommended screening at a younger age 
  • All immigrant, refugee, and internationally adopted children when they arrive in the United States 
  • Neonates and infants born to women with lead exposure during pregnancy and lactation

Universal screening is recommended by both the CDC and AAP in areas where at least 27% of houses were built before 1950 and in places where the prevalence of elevated blood levels in children aged 1-2 years is 12%. [20, 22]

Targeted screening is recommended in all other areas in which a positive response is received to one or more of the following screening questionnaire items issued by the CDC:

  • Does your child live in or regularly visit a house that was built before 1950?
  • Does your child live in or regularly visit a house that was built before 1978 with recent or ongoing renovations or remodeling (within the past 6 mo)?
  • Does your child have a sibling or a playmate that has or did have lead poisoning?