Recommended Actions Based on Blood Lead Level
Summary of Recommendations for Follow-up and Case Management of Children Based on Confirmed* Blood Lead Levels
Blood Lead Level (BLL) |
|||||
<5 μg/dL |
5–9 μg/dL |
10–19 μg/dL |
20–44 μg/dL |
45–69 μg/dL |
≥70 μg/dL |
Routine assessment of nutritional and developmental milestones Anticipatory guidance about common sources of lead exposure Follow-up blood lead testing at recommended intervals based on child’s age |
Routine assessment of nutritional and developmental milestones Environmental assessment** including detailed history to identify potential sources of lead exposure
Nutritional counseling related to calcium and iron intake Follow-up blood lead testing at recommended intervals based on child’s age |
Routine assessment of nutritional and developmental milestones Environmental investigation** including home visit to identify potential sources of lead exposure Nutritional counseling related to calcium and iron intake; consider lab work to assess iron status Follow-up blood lead monitoring at recommended intervals |
Complete history and physical exam Neurodevelopmental assessment Environmental investigation and lead hazard reduction Lab work:
Abdominal X-ray (with bowel decontamination if indicated) Follow-up blood lead monitoring at recommended intervals |
Complete history and physical exam Complete neurological exam including neuro-developmental assessment Environmental investigation and lead hazard reduction Lab work:
Abdominal X-ray with bowel decontamination if indicated Oral chelation therapy; consider hospitalization, if lead-safe environment cannot be assured Follow-up blood lead monitoring at recommended intervals |
Hospitalize and commence chelation therapy in conjunction with consultation with a medical toxicologist or a pediatric environmental health specialty unit Proceed with additional actions according to interventions for BLLs between 45-69 μg/dL |
μg/dL: micrograms per deciliter
*Confirmed BLL: One venous blood test or two capillary blood lead tests drawn within 12 weeks of each other (see Recommended Schedule for Obtaining a Confirmatory Venous Sample below).
** Environmental assessments and investigations vary according to local conditions based on jurisdictional requirements and available resources
Recommended Schedule for Obtaining a Confirmatory Venous Sample
Blood Lead Level (μg/dL) |
Time to Confirmation Testing |
≥5–9 |
1–3 months |
10–44 |
1 week–1 month* |
45–59 |
48 hours |
60–69 |
24 hours |
≥70 |
Urgently as emergency test |
*The higher the BLL on the screening test, the more urgent the need for confirmatory testing.
Schedule for Follow-Up Blood Lead Testinga
Venous Blood lead Levels (µg/dL) |
Early follow up testing (2-4 tests after identification) |
Later follow up testing after BLL declining |
≥5–9 |
3 months* |
6–9 months |
10–19 |
1–3 months* |
3–6 months |
20–24 |
1–3 months* |
1–3 months |
25–44 |
2 weeks–1 month |
1–months |
≥45 |
As soon as possible |
As soon as possible |
aSeasonal variation of BLLs exists and may be more apparent in colder climate areas. Greater exposure in the summer months may necessitate more frequent follow ups.
*Some case managers or healthcare providers may choose to repeat blood lead tests on all new patients within a month to ensure that their BLL level is not rising more quickly than anticipated.
References:
- Centers for Disease Control and Prevention, 2002. Managing Elevated Blood Lead Levels Among Young Children
- Advisory Committee for Childhood Lead Poisoning Prevention, 2012. Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention
- American Academy of Pediatrics, 2016. Prevention of Childhood Lead Toxicity
The following actions are NOT recommended at any BLL:
- Searching for gingival lead lines
- Testing of neurophysiologic function
- Evaluation of renal function (except during chelation with EDTA)
- Testing of hair, teeth, or fingernails for lead
- Radiographic imaging of long bones
- X-ray fluorescence of long bones
- Page last reviewed: May 17, 2017
- Page last updated: May 17, 2017
- Content source:
National Center for Environmental Health, Division of Emergency and Environmental Health Services