Childhood Lead Poisoning - Provider Information

Updated September 12, 2016

providersNEW! The pediatric blood lead reference value is 5 ug/dL.

Effective March 2015, for children less than 6 years old, providers should confirm all capillary blood lead levels > 5 ug/dL with venous samples, and follow up on all venous blood lead levels > 5 ug/dL. View the Maine CDC recommended capillary confirmation and venous follow-up schedules for pediatric blood lead levels > 5 ug/dL.

Effective September 19, 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.

 

On this page:

Pediatric Blood Lead Screening Guidelines (Updated March 2015)

Efforts to identify potential lead hazards and prevent lead exposure should begin early in a child's life. Lead screening and blood lead testing is based on a child's risk for lead poisoning. Since children rarely display symptoms of lead poisoning, a blood lead test is the only way to know if a child has been exposed to lead.

Recommended Blood Lead Screening Schedule

(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 (9-17 months)*

Blood lead test mandatory**

 Blood lead test unless annual risk assessment questionnaire is negative.
2 years (18-36 months) Blood lead test mandatory** Blood lead test unless annual risk assessment questionnaire is negative.
3-5 years (36-72 months)

1. If not previously tested: conduct blood lead test

2. If previously tested: Blood lead test yearly unless annual risk assessment questionnaire is negative.

 Yearly blood lead test unless annual risk assessment questionnaire is negative.

*Test children as they become mobile. **Maine and federal laws require tests at 1 and 2 years for children covered by MaineCare. Read the Maine State Statute External site disclaimer requiring lead screening and blood lead testing (§1317-D).

Additional Screening Recommendations

Consider a blood lead test between 9 and 72 months for children in the following at-risk groups:

  • Families that qualify for programs such as WIC, Head Start, SNAP
  • 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 screening guidelines for immigrant/refugee children External site disclaimer

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

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Annual Risk Assessment Questionnaire (Updated March 2015)

  1. Does your child spend more than 10 hours per week, in any house built before talk to doctor1950?
  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 screening guidelines, including the annual risk assessment questionnaire. (PDF)

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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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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 Program (MCLPPP). Providers must have approval from the MCLPPP 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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Capillary Lead Test Confirmation Schedule (Effective March 2015)

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
5-9 ug/dL

3 months
10-44 ug/dL 1 month
45-59 ug/dL 48 hours
60-69 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 (Updated September 2016)

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
5-9 ug/dL

3 months

 When <5 resume screening schedule
  • Environmental investigation
  • Case management by phone
10-14 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

 
15-19 ug/dL Within 2 months 3-6 months
20-44 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

 Based on chelation protocol

*Long-term follow-up should only begin after blood lead begins to decline 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 External site disclaimer.

For additional guidance on the management of children at risk of lead exposure, see the 2012 Advisory Committee on Childhood Lead Poisoning Prevention statement: Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention External site disclaimer.

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

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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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Download and Print Reference Materials

Document/Resource Source Size Type

Pediatric Blood Lead Screening Guidelines and Recommended Confirmation and Follow-up Schedule for Pediatric Blood Lead Levels 5 ug/dL or Higher (September 2016)

 Maine Childhood Lead Poisoning Prevention Program 250 KB PDF
Notification to Providers of Changes to Pediatric Blood Lead Testing Recommendations (March 2015) Maine Childhood Lead Poisoning Prevention Program 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 Program

The Maine Childhood Lead Poisoning Prevention Program:

  • 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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