Childhood Lead Poisoning - Provider Information

Updated February 25, 2020

New blood lead testing requirements.

Effective June 27, 2019, Maine law requires blood lead tests for all children at 1 and 2 years of age.

• Use ImmPact to view patient blood lead tests.
• Get a copy of the new testing guidelines. (PDF)
• Read an update about the law change and current testing rates. (PDF)

 

On this page:

• Blood Lead Testing Requirements for Children Ages 1 and 2 Years
• Capillary Lead Test Confirmation Schedule
• Venous Lead Test Follow-Up Schedule
• Additional Screening Recommendations
• Risk Assessment Questionnaire for Children Ages 36-72 Months
• Blood Lead Testing Options
• Billing Information
• Free Home Lead Dust Testing for Patients
• Download and Print Reference Materials
• Publications
• About the Maine Childhood Lead Poisoning Prevention Unit

Blood Lead Testing Requirements for Children Ages 1 and 2 Years (Effective June 2019)

As of June 27, 2019, Maine law requires blood lead tests for all children at 1 and 2 years of age. See below for recommended confirmation and follow-up testing schedule if blood lead level is 5 ug/dL or higher.

Age	Children Covered by MaineCare	Children Not Covered by MaineCare
1 year (9 to <18 months)	Blood lead test mandatory under Maine and federal law	Blood lead test mandatory under Maine law
2 years (18 to <36 months)	Blood lead test mandatory under Maine and federal law	Blood lead test mandatory under Maine law

 

Capillary Lead Test Confirmation Schedule (Effective March 2015)

Effective March 2015, for children less than 6 years old, providers should confirm all capillary blood lead levels 5 ug/dL or higher with venous samples, according to the following schedule. The higher the capillary test result, the more urgent the need for a confirmatory venous test. A venous test must be done prior to initiation of Maine CDC services.

Capillary Blood Lead Level	Confirm with Venous Test Within
5 - <10 ug/dL	3 months
10 - <45 ug/dL	1 month
45 - <60 ug/dL	48 hours
60 - <70 ug/dL	24 hours
70+ ug/dL	Immediately as an emergency test

Get a printable copy of recommended capillary lead test confirmation schedule. (PDF)

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Venous Lead Test Follow-up Schedule (Effective September 2016)

Effective September 2016, the Maine CDC provides a full lead investigation of a child's home environment when a venous blood lead test result is 5 ug/dL or higher. For all venous blood lead levels 5 ug/dL or higher, conduct follow-up venous blood lead tests, according to the following schedule. The Maine CDC initiates a response on venous results of 5 ug/dL and above.

Venous Blood Lead Level	Follow-up Venous Test Schedule	Long-Term Follow-Up*	Maine CDC Response
5 - <10 ug/dL	3 months	When <5 resume testing schedule	Environmental investigation Case management by phone
10 - <15 ug/dL	Within 3 months	6-9 months	For children with blood lead levels 10 ug/dL or higher: Environmental investigation Case management by phone Offer home visit from public health nurse
15 - <20 ug/dL	Within 2 months	3-6 months
20 - <45 ug/dL	Within 1 month	1-3 months
45+ ug/dL	Repeat venous blood test immediately Chelation therapy as indicated Consider consult with New England Pediatric Environmental Health Specialty Unit: 617-355-8177 Or Northern New England Poison Center: 1-800-222-1222	Based on chelation protocol

*Long-term follow-up should only begin after blood lead is declining and child is living in a lead-safe environment.

For additional guidance on the management of children with lead poisoning see the American Academy of Pediatrics website .

For additional guidance on the management of children at risk of lead exposure, see the .

Get a printable copy of recommended venous lead test follow-up schedule. (PDF)

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Additional Testing Recommendations

Recommended Blood Lead Testing Schedule for Children Ages 3 to 5 Years

Age	Children Covered by MaineCare	Children Not Covered by MaineCare
3-5 years (36-72 months)	1. If not previously tested: Mandatory blood lead test 2. If previously tested: Recommend blood lead test yearly unless annual risk assessment questionnaire is negative.	Recommend blood lead test yearly unless annual risk assessment questionnaire is negative.

Recommended Testing for At-Risk Groups

In addition to testing children at ages 1 and 2 years, consider a blood lead test for children in the following at-risk groups:

• Recent immigrants or international adoptees
• Children whose parents immigrated to the U.S.

Consider a blood lead test, regardless of age, if children have any of the following conditions:

• Unusual oral behavior, pica, developmental delays, behavioral problems, ADHD
• Unexplained illness: severe anemia, lethargy, abdominal pain
• Ingestion of paint chip or object that might contain lead

Recommended Testing Schedule for 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

Get a printable copy of blood lead testing guidelines. (PDF)

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Risk Assessment Questionnaire for Children Ages 36-72 Months (Updated March 2015)

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?

If a child’s parent answered “yes,” or "does not know," to one or more of these questions, the child should be given a blood lead test.

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

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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.

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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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Free Home Lead Dust Testing for Patients

Dust from deteriorating, damaged, or exposed lead paint in older homes is the most common source of pediatric lead poisoning. Providers and families may request a free, do-it-yourself lead dust test kit before a child becomes poisoned. Call to order: 207-287-4311, TTY 711; or order online.

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Additional Information

Document/Resource	Source	Size	Type
Webinar Recording on Universal Blood Lead Testing Mandate (YouTube)	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
Pediatric Blood Lead Testing Guidelines and Recommended Confirmation and Follow-up Schedule for Pediatric Blood Lead Levels 5 ug/dL or Higher (October 2019)	Maine Childhood Lead Poisoning Prevention Unit	250 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

• 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

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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.

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