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Childhood Lead Poisoning - Provider Information
Updated November 15, 2022
New blood lead testing guidelines.
Follow Maine CDC Guidelines and test all children for lead poisoning at 1 and 2 years of age. Effective October 1, 2022, providers should confirm all capillary blood lead levels 3.5 ug/dL or higher with venous samples.
- Get a copy of the new testing guidelines (PDF)
- Learn more about confirmation testing at 3.5 ug/dL
- Use ImmPact to view patient blood lead tests.
On this page:
Blood Lead Testing Requirements (Effective October 2022)
Maine CDC provides services based on venous lead levels 3.5 ug/dL or higher. The initial blood lead screening test may be either a venous or capillary sample. An elevated capillary sample (>3.5 ug/dL) must be confirmed with a venouos sample.
Maine law requires blood lead tests for all children at 1 and 2 years of age.
| Age | Blood Lead Testing Requirements |
|---|---|
1 year (9 to <18 months) |
Mandatory under Maine law |
2 years (18 to <36 months) |
Mandatory under Maine law |
3-5 years (36 to 72 months) |
For children covered by MaineCare:
|
Risk Assessment Questionnaire - Identifies at-risk children under 6 years of age
If a child's parent or guardian answers 'yes' or 'don't know' to any of the questions below, test the child for lead.
- Does your child spend more than 10 hours per week in any house built before 1950?
- Does your child spend more than 10 hours per week in any house built before 1978 that was renovated or remodeled within the last 6 months?
- Does your child spend time with an adult whose job exposes him/her to lead? (Examples: construction, painting, metalwork)
- Does your child have a sibling or playmate that has been diagnosed with lead poisoning?
Additional Testing Recommendations
Test at-risk populations annually through 5 years of age, and as clinically indicated, even if the risk assessment questionnaire is negative.
At-risk populations:
- Recent immigrants or international adoptees
- Children whose parents immigrated to the U.S.
- Children with pica behavior
- Children with neurodevelopmental disabilities or conditions such as autism that put them at higher risk for hand-to-mouth behavior
- Children entering foster care
Test all recently arrived refugee children.
- Perform a blood lead test for children 6 months to 16 years upon entry to the U.S.
- Within 3-6 months of initial test, conduct follow-up test for children 6 months to 6 years, regardless of initial test result.
- Consult U.S. CDC Recommendations for Lead Poisoning Prevention in Newly Arrived Refugee Children. Download a copy of the Recommendations
Get a printable copy of blood lead testing guidelines. (PDF)
Recommended Confirmation and Follow-up Schedule (Effective October 2022)
The pediatric blood lead reference level is 3.5 ug/dL or higher.
- Confirm capillary screening test results 3.5 ug/dL or higher with a venous test.
- The sooner providers confirm capillary blood lead tests with venous specimens, the sooner Maine CDC can initiate services to identify and eliminate the sources of their lead exposure.
- The higher the capillary test result, the more urgent the need for a confirmatory venous test.
- Confirmatory testing is not required when an initial screening test is performed using a venous sample.
Capillary Lead Test Confirmation Schedule
| Capillary Blood Lead Level | Confirm with Venous Test Within |
|---|---|
3.5 - <10 ug/dL |
As soon as possible, but no later than 3 months |
10 - <20 ug/dL |
As soon as possible, but no later than 1 month |
20 - <45 ug/dL |
As soon as possible, but no later than 2 weeks |
45+ Urgent Action Needed |
Immediately, but no later than 48 hours (place order as STAT) |
Venous Lead Test Follow-up Schedule
| Venous Blood Lead Level | Follow-up Venous Test Schedule | Recommended Actions Based on Confirmed Venous BLL |
|---|---|---|
3.5 - <10 ug/dL |
Within 3 months* |
|
10 - <20 ug/dL |
Within 2 months* |
|
20 - <45 ug/dL |
Within 1 month* |
|
45+ ug/dL Urgent Action Needed |
Immediately (place order as STAT) |
|
*You may elect to repeat blood lead tests on children with an elevated venous blood lead level within 1 month to ensure that the blood lead level is not rising. Consult U.S. CDC guidelines.
Maine CDC's Public Health Response for Confirmed Venous Blood Lead Levels at or Above 3.5 ug/dL
| Maine CDC Childhood Lead Poisoning Prevention Unit Response for Children (Ages 0 to less than 72 months) with Venous Lead Levels | 3.5 - <5 ug/dL | 5 - <10 ug/dL | 10 - <45 ug/dL | 45+ ug/dL |
|---|---|---|---|---|
Offer free home lead dust test and if dust levels are high, provide environmental investigation and case management services described below |
X | |||
Conduct environmental investigation of the child’s home to identify and remove lead hazards |
X | X | X | |
Provide case management services to: discuss outcomes of investigation, prevent further exposure, and monitor blood lead level |
X | X | X | |
Offer home visit from a public health nurse |
As Needed | X | X | |
CDS referral (lead poisoning is a qualifying diagnosis for CDS) |
X | X | X | |
Coordinate with providers and Northern New England Poison Center on urgent evaluation for chelation therapy and investigation of the child’s home environment for lead hazards |
X |
Get a printable copy of recommended venous lead test follow-up schedule. (PDF)
Free Home Lead Dust Testing for Patients
- Providers and families may request a free, do-it-yourself lead dust test kit to identify lead dust in a child’s home before a child becomes poisoned.
- These test kits are ideal for families who live in pre-1950 housing, and that have infants (less than 1 year old), are expecting a new baby, or have a child with a blood lead level <3.5 ug/dL.
- To order a test kit 207-287-4311, TTY 711; or order online.
Blood Lead Testing Options
Providers now have two options for blood lead testing:
1) Continue to submit blood lead samples to the State Health and Environmental Testing Laboratory; 2) Perform capillary blood lead analysis using a CLIA waived in-office blood lead testing device and directly report all test results to the Maine CDC Childhood Lead Poisoning Prevention Unit (MCLPPU). Providers must have approval from the MCLPPU before they can begin in-office testing.
- For providers sending blood lead samples to the State Health and Environmental Testing Laboratory:
- Collect either a capillary or venous specimen. To prevent false positive capillary samples, wash and scrub the finger or toe that you will be testing with soap. Use a surgical brush or soft toothbrush.
- For free blood collection supplies and mailers, providers may call the State of Maine Health and Environmental Testing Lab (HETL) at 207-287-2727.
- For providers interested in beginning in-office testing, get complete information about the approval and application process and data reporting requirements.
Billing Information for Blood Lead Tests
For questions about billing:
- Call your MaineCare provider relations specialist at 866-690-5585, TTY 711.
- Call the Maine Health and Environmental Testing Lab (HETL) at 207-287-2727.
Additional Information
Call the lead program or see our resources page for DVD's and print materials on preventing lead poisoning for your patients.
Publications
- Advisory Committee on Childhood Lead Poisoning Prevention Statement (2012):
- Environmental Health Perspectives (2008): US
Children's Lead Exposures, 2008: Implications for Prevention
- U.S. Centers for Disease Control and Prevention (2006): Recommendations
for Lead Poisoning Prevention in Newly Arrived Refugee Children
- American Academy of Pediatrics Policy Statement (2009): Lead
Exposure in Children: Prevention, Detection and Management
About the Maine Childhood Lead Poisoning Prevention Unit
The Maine Childhood Lead Poisoning Prevention Unit:
- Monitors approximately 15,000 blood lead tests each year.
- Identifies children with elevated blood lead levels.
- Provides services to families based on the child's blood lead level.
- Conducts lead environmental testing of residences for children with venous blood leads 5 ug/dL and greater.
- Works with families, their physicians, visiting nurses, and lead inspectors to make sure blood lead levels return to normal.
- Provides education to professionals, parents, and the public on lead poisoning.
- Gathers ongoing epidemiological surveillance to determine what lead poisoning looks like in Maine. You can view this data by visiting the Maine Environmental Public Health Tracking Portal.
If you have questions about blood lead testing, please contact Dr. Margaret Bordeau, Public Health Physician, at margaret.bordeau@maine.gov.
Change to Guidelines for Specimen Collection Tubes for Venous Whole Blood Lead Analyses
-
Read Maine CDC's Public Health Advisory about changes to guidelines for submitting venous whole blood lead specimens to the Maine CDC’s Health and Environmental Testing Laboratory. Download the advisory or read the FAQ document.
(posted 11/15/2022)
New Pediatric Blood Lead Testing Guidelines
-
Providers should now conduct venous confirmatory and follow-up testing for children up to age 6 years with a blood lead level at or above 3.5 ug/dL. Download the new testing guidelines or read an update on the changes.
(posted 10/4/2022)
Information for Providers on the LeadCareII Recall
-
Read Maine CDC's guidance for providers on re-testing patients affected by the June 2021 LeadCareII test kit recall. Download the new guidance.
(posted 7/20/2021)
Blood Lead Module in ImmPact Now Available
- Learn about a new module in ImmPact that lets you track and view patients' blood lead tests.
