Guidelines and Recommendations

Note

Some of the documents below refer to a blood lead level of 5 micrograms per deciliter (μg/dL) as the CDC's blood lead reference value. CDC uses a blood lead reference value of 3.5 micrograms per deciliter (µg/dL) to identify children with blood lead levels that are higher than most children's levels. This level is based on the 97.5th percentile of the blood lead values among U.S. children ages 1-5 years from the 2015-2016 and 2017-2018 National Health and Nutrition Examination Survey (NHANES) cycles. Children with blood lead levels at or above the BLRV represent the top 2.5% with the highest blood lead levels.

Some of the documents on this page are presented for historical purposes and are not being maintained or updated.

** These documents are being kept on this website for historical purposes and are no longer in print.

Healthcare systems/insurance guidelines

• A Purchaser's Guide to Clinical Preventive Services: Moving Science into Coverage (2006) – This is an important resource on preventive services, including elevated blood lead level screening. The guide translates clinical guidelines and medical evidence, providing large employers with the information they need to select, define, and implement preventive medical benefits. The section on elevated blood lead level screening starts on page 164 of the guide, under the Evidence Statement for Child Health Promotion. The guide was developed by CDC, the Agency for Healthcare Research and Quality, and the National Business Group on Health.
• Overcoming Barriers to Data-Sharing Related to the HIPAA Privacy Rule: A Guide for State and Local Childhood Lead Poisoning Prevention Programs – This guide reviews HIPAA requirements and exceptions, focusing on those for public health agencies, and describes permissible uses of lead-related data under the HIPAA Privacy Rule.
• HIPAA Privacy Rule and Public Health: Guidance from CDC and the U.S. Department of Health and Human Services

Primary prevention guidelines

• Recommendations of the Advisory Committee for Childhood Lead Poisoning Prevention (ACCLPP) "Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention"
• CDC Response to Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) Recommendations in "Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention
• Building Blocks for Primary Prevention: Protecting Children from Lead-Based Paint Hazards (2005) – This publication offers a comprehensive collection of 70 "building blocks," which are primary prevention strategies to reduce exposure to hazards in housing. More information about the publication. Source: Alliance for Healthy Homes
• Preventing Lead Exposure in Young Children: A Housing-Based Approach to Primary Prevention of Lead Poisoning (2004) – This document presents recommendations from the Centers for Disease Control and Prevention's Advisory Committee on Childhood Lead Poisoning Prevention for a housing-based approach to primary prevention of childhood lead poisoning to accelerate progress towards the elimination of elevated blood lead levels in children.

Screening and case management guidelines

• Mission Unleaded: How to test children for lead with maximum accuracy – reducing the risk of contamination during blood collection for lead testing.
• Educational Services for Children Affected by Lead Expert Panel. Educational interventions for children affected by lead. (2015)

Note: CDC uses a blood lead reference value of 3.5 micrograms per deciliter (µg/dL) to identify children with blood lead levels that are higher than most children's levels. This level is based on the on the 97.5th percentile of the blood lead values among U.S. of children ages 1-5 years from the 2015-2016 and 2017-2018 National Health and Nutrition Examination Survey (NHANES) cycles. Children with blood lead levels at or above the BLRV represent those at the top 2.5% with the highest blood lead levels.

The documents below refer to a blood-lead level of 10 micrograms per deciliter (μg/dL) as the CDC level of concern for adverse health outcomes in children. This terminology is outdated, and readers are referred to the ACCLPP recommendations of 2012.

• CDC. Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women (2010) – These guidelines are based on scientific data and practical considerations regarding preventing lead exposure during pregnancy, assessment and blood lead testing during pregnancy, medical and environmental management to reduce fetal exposure, breastfeeding, and follow up of infants and children exposed to lead in utero.
• CDC. Recommendations for Blood Lead Screening of Medicaid-Eligible Children Aged 1–5 Years: an Updated Approach to Targeting a Group at High Risk. MMWR. August 7, 2009; 58(RR09);1-11.
• CDC. Interpreting and Managing Blood Lead Levels <10 µg/dL in Children and Reducing Childhood Exposures to Lead: Recommendations of CDC's Advisory Committee on Childhood Lead Poisoning Prevention. MMWR. November 2, 2007; 56(RR08):1-14;16.Erratum: Vol. 56, No. RR-8 MMWR. November 30, 2007; 56(47):1241-1242.
• Recommendations for Preventing Lead Poisoning among the Internally Displaced Roma Population in Kosovo from the Centers for Disease Control and Prevention (2007) – Lead exposure is a continuing urgent health problem for Roma in Kosovo. The Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and the United Nations International Children's' Emergency Fund (UNICEF) have collaborated in blood lead surveillance of the Roma children living in refugee camps in Kosovo. This document includes recommendations.
• Managing Elevated Blood Lead Levels Among Young Children: Recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention (2002) – This report from the Advisory Committee on Childhood Lead Poisoning Prevention is intended to facilitate the management of children with elevated blood lead levels by providing case managers with information and guidance.
• CDC. Recommendations for Blood Lead Screening of Young Children Enrolled in Medicaid: Targeting a Group at High Risk—United States. MMWR. December 8, 2000; 49(RR-14):1-13.
• Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials, Centers for Disease Control and Prevention (1997) – The policy outlined in the document has two main purposes: to increase screening and follow-up care of children who most need these services, and to help communities pursue the most appropriate approach to the prevention of childhood lead poisoning.

Surveillance guidelines

• Technical Guide, Small Area Surveillance to Estimate Prevalence of Childhood Blood and Environmental Lead Levels (2016)
  • Conducting Blood Lead Prevalence Studies Training Module
  • Conducting Environmental Sampling Training Module
• Using GIS to Assess and Direct Childhood Lead Poisoning Prevention: Guidance for State and Local Childhood Lead Poisoning Prevention Programs (2004) – These guidelines were prepared to help new lead epidemiologists quickly learn how to use geographic information systems (GIS) mapping technology to assess and direct childhood lead poisoning elimination efforts.

Lead toxicology reports

• Interaction Profile for Lead, Manganese, Zinc, and Copper – The ATSDR Interaction Profile succinctly characterizes the toxicologic and adverse health effects information for mixtures of hazardous substances. (May, 2004).
• ToxFAQs™ for Lead – This fact sheet answers the most frequently asked health questions about lead.
• Toxicological Profile for Lead – This ATSDR toxicological profile succinctly characterizes the toxicologic and adverse health effects information for lead.