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Childhood Lead Poisoning Prevention
CDC updates blood lead reference value to 3.5 µg/dLCDC updates blood lead reference value to 3.5 µg/dL
CDC uses a blood lead reference value (BLRV) of 3.5 micrograms per deciliter (µg/dL) to identify children with blood leadCDC uses a blood lead reference value (BLRV) of 3.5 micrograms per deciliter (µg/dL) to identify children with blood lead
levels that are higher than most children’s levels.levels that are higher than most children’s levels.
On October 28, 2021, CDC updated the blood lead reference value (BLRV) from 5.0 μg/dL to 3.5 μg/dL. A BLRV is intended
to identify children with higher levels of lead in their blood compared with levels in most children. The value is based on
the 97.5th percentile of the blood lead distribution in U.S. children ages 1–5 years. By updating the BLRV to 3.5 μg/dL,
children with blood lead levels (BLLs) within the range of 3.5–5 μg/dL can now also receive prompt actions to mitigate
health e ects and remove or control exposure sources.
Updating the reference value encourages CDC, federal agencies, health departments, providers, communities, and other
partners to take the following steps:
Focus resources on children with the highest levels of lead in their blood compared with levels in most children in that
age range
Identify and eliminate sources of lead exposure
Take more prompt actions to reduce the harmful e ects of lead
The BLRV is a population-based measurement that now indicates that 2.5% of U.S. children aged 1–5 years have BLLs at
or above 3.5 μg/dL. It is not a health-based standard or a toxicity threshold. The BLRV should be used as a guide to 1) help
determine whether medical or environmental follow-up are recommended and 2) prioritize communities with the most
need for primary prevention of exposure.
Updating the BLRV supports CDC’s commitment to health equity and addressing environmental justice. The risk for lead
exposure is not the same for all children. There are signi cant disparities in health outcomes across racial and ethnic
groups and people with di erent socioeconomic status. Higher blood lead levels are more prevalent among children
from racial and ethnic minority groups, children from low-income households, and children who live in housing built
before 1978. Also, children from racial and ethnic minority groups are more likely to live in conditions where there is
greater likelihood of exposure. Some of these conditions include poor housing and environmental exposures, such as
lead in air, soil, and water.
CDC recommends that public health and clinical professionals focus screening e orts on neighborhoods and children at
high risk, based on age of housing and socioeconomic risk factors:
Public health and clinical professionals should collaborate to develop screening plans responsive to local conditions,
using local data.
In the absence of such plans, universal BLL testing is recommended.
Jurisdictions should follow the Centers for Medicare & Medicaid Services requirement that all Medicaid-enrolled
children be tested at ages 12 months and 24 months or at age 24–72 months if they have not previously been
screened.
Protecting children from exposure to lead is important to lifelong good health. No safe BLL in children has been
identi ed. Even low levels of lead in blood have been shown to reduce a child’s learning capacity, ability to pay attention,
and academic achievement.
Some e ects of exposure to lead can be permanent. If caught early, however, parents, healthcare providers, and
communities can take actions to prevent further exposure and reduce damage to a child’s health. The most important
step parents and caregivers, healthcare providers, and public health professionals can take is to prevent lead exposure
before it occurs.
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Frequently Asked Questions
What is CDC’s blood lead reference value?CDC has been involved in de ning the criteria for interpreting blood lead levels in children for more than 40 years. In
2012, CDC introduced the concept of a blood lead reference value (BLRV) to identify children with higher levels of
lead in their blood compared with levels in most children. The BLRV is based on the 97.5th percentile of the blood
lead distribution in U.S. children ages 1–5 years. In 2012, the BLRV in children was established to be 5 micrograms
per deciliter (µg/dL). In 2021, CDC updated the BLRV in children to 3.5 μg/dL.
The BLRV is based on data from two consecutive cycles of the National Health and Nutrition Examination Survey
(NHANES). The BLRV is updated periodically to re ect changes in the population. The current update is based on data
from the 2015–2018 NHANES cycles.
Why did CDC update the blood lead reference value?The blood lead reference value (BLRV) is based on the 97.5th percentile of blood lead distribution in children, as
determined from National Health and Nutrition Examination Survey (NHANES) data. The updated blood lead
reference value is based on NHANES data from 2015–2016 and 2017–2018. CDC’s Federal Advisory Committee, called
the Lead Exposure and Prevention Advisory Committee, unanimously voted on May 14, 2021, in favor of updating
the reference value to 3.5 μg/dL, based on data from the 2015–2018 NHANES cycles.
Updating the reference value allows CDC, healthcare providers, federal agencies, and health departments to focus
resources on children with the highest exposure to lead compared with most children in that age range. By updating
the BLRV to 3.5 μg/dL, children with blood lead levels within the range of 3.5–5 μg/dL will now also be identi ed to
receive prompt actions to mitigate health e ects and control potential exposure sources.
Does CDC work with other groups that have a role in lead poisoning prevention?Yes, CDC works with other federal agencies, CDC-funded lead grantees, and public health and medical partners to
keep healthcare providers and the public informed.
What is a “reference value”?No safe level of lead in children has been identi ed. Even low levels of lead in blood have been shown to reduce
children’s IQ, ability to pay attention, and academic achievement. Because any blood lead level can harm children,
our focus is on eliminating exposure in the rst place.
If a child has a blood lead level below the blood lead reference value (BLRV), it does not mean a child is free from
harm caused by lead exposure. The reference value simply shows the value at which a child has more lead in their
blood than most U.S. children (97.5% of children age 1–5 years).
6/23/22, 10:26 AM CDC updates blood lead reference value | Lead | CDC
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The primary di erence between the prior BLRV of 5 µg/dL and the current BLRV of 3.5 µg/dL is that children with a
blood lead level within the 3.5–5 µg/dL range will now also be identi ed as having lead exposure greater than 97.5%
of children. This can encourage prompt action to mitigate harmful health e ects and removal or control of lead
exposure sources. CDC recommends that children with BLLs of 3.5 µg/dL and higher receive routine assessment of
nutritional and developmental milestones, environmental exposure history to identify potential sources of lead
exposure, nutritional counseling related to calcium and iron intake, and follow-up blood lead level testing at
recommended intervals based on the child’s age. CDC provides a summary of Recommended Actions Based on
Blood Lead Level.
What is lead poisoning?Lead poisoning or lead toxicity refers to exposures to lead that result in illness and require immediate medical
attention. It is used to describe cases when there are severe health e ects related to high blood lead levels. If blood
lead levels are 45 micrograms per deciliter (μg/dL) or greater, healthcare providers may recommend medication to
help remove lead from the body. However, children are highly sensitive to lead and exposure at lower levels has
been shown to cause harm. CDC provides a summary of Recommended Actions Based on Blood Lead Level.
Many factors a ect how di erent people’s bodies handle exposure to lead. These factors include a person’s age,
nutritional status, source of lead exposure, amount of lead exposure, underlying health conditions, and length of
exposure. Many children exposed to lead have no obvious symptoms. Some exposures, however, cause more
obvious health e ects that need urgent treatment.
No level of lead exposure or lead in the body is safe for children. Even low levels of lead that were once considered
safe have been linked to harmful changes in intelligence, behavior, and health. Children are most at risk because
they are still developing physically and mentally.
A blood lead reference value (BLRV) of 3.5 micrograms per deciliter (µg/dL) can be used to identify children with
blood lead levels higher than those of most U.S. children, determine appropriate follow-up actions, and prevent
further exposure. The BLRV is simply the level at which a child has more lead in their blood than do most U.S.
children (97.5% of children age 1–5 years).
If you are concerned that your child has been exposed to lead, contact their healthcare provider to get a blood lead
test. Based on the results of the test, actions can be taken to reduce further exposure to lead and connect them to
recommended treatment and services. Lead exposure is preventable.
What are the bene ts of updating the blood lead reference value for children age less than 6 years
old from 5 µg/dL to 3.5 µg/dL?There is no safe level of lead in blood. Updating the reference value encourages CDC, federal partners, and health
departments to focus on young children, under age of 6 years, with the highest exposure to lead compared with
most U.S. children. This is part of the nation’s ongoing e ort to reduce blood lead levels even further and identify
sources of exposure to those young children at highest risk for continued exposures.
The primary di erence between the previous blood lead reference value (BLRV) of 5 µg/dL and the updated BLRV of
3.5 µg/dL is that children with a blood lead level (BLL) within the 3.5–5 µg/dL range will also be prioritized for lead
reduction action. With the updated BLRV, children with higher BLLs will continue to be eligible for the same targeted
services as previously described. CDC recommends that children with BLLs of 3.5 µg/dL and higher receive routine
assessment of nutritional and developmental milestones, environmental assessment of detailed history to identify
potential sources of lead exposure, nutritional counseling related to calcium and iron intake, and follow-up BLL
testing at recommended intervals based on the child’s age.
6/23/22, 10:26 AM CDC updates blood lead reference value | Lead | CDC
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Despite the overall decline of blood lead levels over time, lead exposure remains a signi cant public health concern
for some young children because of persistent lead hazards in the environment and hand to mouth activity that is
common among this age group. Sources of lead include lead-based paint, lead service lines, lead in household
plumbing material, and soil contaminated by past sources, such as automobile gasoline and hazardous waste sites.
Young children can also be exposed to lead in contaminated food, folk remedies, cultural products, and consumer
products. Young children can also be exposed to lead secondhand if a parent or other adult they spend time with
works or engages in recreational activities that involve lead or lead-based products.
How might health departments use this new level?Health departments may use the blood lead reference value (BLRV) in recommendations that involve follow-up
evaluation of young children under 6 years, after blood lead level testing. They can use the reference value to identify
high-risk populations and geographic areas most in need of lead exposure prevention. Health departments can
guide targeted interventions to reduce lead exposure in children by identifying hotspots for potential lead exposure
and prioritizing where to focus blood lead screening, outreach, and community interventions.
CDC’s BLRV is a screening tool to identify children who have higher levels of lead in their blood compared with most
children. The reference value is not health-based and is not a regulatory standard. States independently determine
action thresholds based on state laws, regulations, and resource availability. CDC encourages healthcare providers
and public health professionals to follow the recommended follow-up actions based on con rmed blood lead
levels.
What might this new level a ect laboratory reporting?The Division of Laboratory Sciences in CDC’s National Center for Environmental Health compiled and reviewed
laboratory pro ciency data [PDF – 828 KB] through the Lead and Multi-element Pro ciency Program. It concluded
that current available laboratory tests for measuring blood lead can reliably measure blood lead levels of 3.5 μg/dL
and greater.
CDC will continue to assist laboratories, healthcare providers, and health departments to overcome the challenges of
measuring and managing lower levels of blood lead in children. CDC developed a template for clinical laboratories to
report blood lead test results on the blood lead laboratory report. This reporting template identi es the BLRV and
delineates risk-based intervals that represent escalating priorities for public health and medical intervention.
What does this mean for healthcare professionals?Healthcare professionals should interpret the blood lead levels (BLLs) of their patients in accordance with the
updated blood lead reference value (BLRV). They should then determine the need for follow-up testing and
interventions for those children identi ed with BLLs at or above the BLRV. CDC has developed outreach materials to
assist healthcare professionals. These can be found on our healthcare provider’s webpage.
What does this mean for parents of children who test above 3.5 µg/dL?
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The primary di erence between a blood lead reference value of 3.5 µg/dL and 5 µg/dL is that children with blood
lead levels within the 3.5–5 µg/dL range will also be prioritized for lead exposure reduction actions. Even low levels of
lead in blood have been shown to a ect a child’s intelligence, ability to pay attention, and academic achievement.
Who will pay for the testing and interventions needed? (Follow up tests for children with lower
levels)The blood lead reference value is based on a percentile of the population distribution of blood lead levels (BLLs).
Because population growth has been relatively stable, the number of children with BLLs equal to or higher than 3.5
µg/dL today should be similar to the number of children with BLLs equal to or higher than 5 µg/dL in 2012.
Therefore, overall national costs should not change much. Children can be given a blood test to measure the level of
lead in their blood. These tests are covered by Medicaid and most private health insurance. Costs associated with
additional recommended actions will vary based on individual factors (e.g., health insurance status, recommended
intervention, programs available in the jurisdiction). If the child’s BLL is 3.5 µg/dL or higher, CDC recommends that
the child be referred for a follow-up venous blood test to assess the next steps. More information on follow-up can
be found at Recommended Actions Based on Blood Lead Level.
What children should be tested? Or retested?CDC recommends targeted screening e orts to focus on children having sociodemographic risk factors and those
living in housing built before 1978. Public health and clinical professionals should collaborate to develop screening
plans responsive to local conditions using local data. Lacking such plans, universal blood lead testing is appropriate.
Additionally, CDC recommends that jurisdictions follow the Centers for Medicare & Medicaid Services requirement
that all Medicaid-enrolled children be tested at ages 12 months and 24 months, or at ages 24–72 months if not
previously been screened.
How does the blood lead reference value t in with CDC’s lead poisoning prevention e orts?CDC’s lead poisoning prevention e orts and the updated blood lead reference value (BLRV) align well with the
Federal Lead Action Plan’s and CDC’s goals to reduce children’s exposure to lead. Updating the BLRV is a step
in achieving health equity and environmental justice. The risk for lead exposure is not the same for all children.
There are signi cant disparities in health outcomes across racial and ethnic groups and people with di erent
socioeconomic status. Higher blood lead levels are more prevalent among children from racial and ethnic minority
groups, children from low-income households, and children who live in housing built before 1978. Also, children
from racial and ethnic minority groups are more likely to live in conditions where there is greater likelihood of
exposure. Some of these conditions include poor housing and environmental exposures, such as lead in air, soil, and
water.
Additional Resources
MMWR Policy Note: Update of the Blood Lead Reference Value — United States, 2021.
Press Release: CDC Updates Blood Lead Reference Value for Children
Recommended Actions Based on Con rmed Blood Lead Level
6/23/22, 10:26 AM CDC updates blood lead reference value | Lead | CDC
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Recommended Actions Based on Con rmed Blood Lead Level
Communication Briefs – information for CDC partners for implementing 3.5 μg/dL as the updated CDC Blood Lead
Reference Value
Healthcare Providers [PDF – 243 KB]
State and Local Health Departments [PDF – 197 KB]
State and Local Laboratories [PDF – 313 KB]
Page last reviewed: March 25, 2022