Childhood Lead Poisoning - Provider Information

Updated November 15, 2022

providers

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.

 

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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:

  • If not previously tested: Mandatory blood lead test
  • If previously tested: Recommend blood lead test yearly unless risk assessment questionnaire is negative
For children not covered by MaineCare:
  • 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.

  1. Does your child spend more than 10 hours per week in any house built before 1950?
  2. 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?
  3. Does your child spend time with an adult whose job exposes him/her to lead? (Examples: construction, painting, metalwork)
  4. Does your child have a sibling or playmate that has been diagnosed with lead poisoning?

Get a printable copy of blood lead testing guidelines, including the risk assessment questionnaire. (PDF)

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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)

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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*

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

10 - <20 ug/dL

Within 2 months*

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

20 - <45 ug/dL

Within 1 month*

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

45+ ug/dL


Urgent Action Needed

Immediately


(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

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)

 

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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.

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Blood Lead Testing Options

Providers now have two options for blood lead testing:capillary test 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.

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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.

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Additional Information

Document/Resource Source Size Type
Pediatric Blood Lead Testing Guidelines and Recommended Confirmation and Follow-up Schedule for Pediatric Blood Lead Levels 3.5 ug/dL or Higher (October 2022) Maine Childhood Lead Poisoning Prevention Unit 320 KB PDF
Notification to Providers on the New Blood Lead Testing Requirements (October 2022) Maine Childhood Lead Poisoning Prevention Unit 200 KB PDF
Webinar Recording on Universal Blood Lead Testing Mandate (YouTube)External site disclaimer Maine Childhood Lead Poisoning Prevention Unit N/A Web
PowerPoint Slides from Universal Blood Lead Testing Mandate Recorded Webinar Maine Childhood Lead Poisoning Prevention Unit 2,757 KB PDF
Notification to Providers on the New Blood Lead Testing Requirements (September 2019) Maine Childhood Lead Poisoning Prevention Unit 280 KB PDF
Notification to Providers of Changes to Pediatric Blood Lead Testing Recommendations (March 2015) Maine Childhood Lead Poisoning Prevention Unit 296 KB PDF
Clinical Lab Requisition Form Maine Health and Environmental Testing Laboratory 164 KB PDF

Call the lead program or see our resources page for DVD's and print materials on preventing lead poisoning for your patients.

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Publications

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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.

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