Childhood Lead Poisoning - Provider Information

providers

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.

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.

Mandatory under Maine law

3-5 years (36 to 72 months)

If not previously tested: Mandatory blood lead test
If previously tested: Recommend blood lead test yearly unless risk assessment questionnaire is negative

Recommend blood lead test yearly unless risk assessment questionnaire is negative

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.

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

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

As soon as possible, but no later than 3 months

As soon as possible, but no later than 1 month

As soon as possible, but no later than 2 weeks

Immediately, but no later than 48 hours

(place order as STAT)

Venous Lead Test Follow-up Schedule

Within 3 months*

Complete risk assessment questionnaire to identify potential sources of exposure
Educate on key messages
Inform patient that Maine CDC will be reaching out

Within 2 months*

Items above plus:
Ensure child does not have iron deficiency
Check child's development to ensure appropriate milestones are being met

Items above plus:
Consider performing abdominal x-ray to check for lead-based paint chips and other radiopaque foreign bodies

Urgent Action Needed

(place order as STAT)

Items above plus:
Perform complete hisotry and physical exam including detailed neurological exam
Urgent consult with Northern New England Poison Center: 1-800-222-1222

*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

Offer free home lead dust test and if dust levels are high, provide environmental investigation and case management services described below

Conduct environmental investigation of the child’s home to identify and remove lead hazards

Provide case management services to: discuss outcomes of investigation, prevent further exposure, and monitor blood lead level

Offer home visit from a public health nurse

CDS referral (lead poisoning is a qualifying diagnosis for CDS)

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

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

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