Lead is a metal that occurs naturally in the earth's crust. Lead can be found in all parts of our environment. Much of it comes from human activities such as mining and manufacturing. Lead used to be in paint; older houses may still have lead paint. You could be exposed to lead by

• Eating food or drinking water that contains lead. Water pipes in older homes may contain lead.
• Working in a job where lead is used
• Using lead in a hobby, such as making stained glass or lead-glazed pottery
• Using folk remedies such as herbs or foods that contain lead

Breathing air, drinking water, eating food, or swallowing or touching dirt that contains lead can cause many health problems. Lead can affect almost every organ and system in your body. In adults, lead can increase blood pressure and cause infertility, nerve disorders, and muscle and joint pain. It can also make you irritable and affect your ability to concentrate and remember.

Lead is especially dangerous for children. A child who swallows large amounts of lead may develop anemia, severe stomachache, muscle weakness, and brain damage. Even at low levels, lead can affect a child's mental and physical growth.

What is Lead?

Lead is a naturally occurring element found in small amounts in the earth’s crust. While it has some beneficial uses, it can be toxic to humans and animals, causing health effects.

Where is Lead Found?

Lead can be found in all parts of our environment – the air, the soil, the water, and even inside our homes. Much of our exposure comes from human activities including the use of fossil fuels including past use of leaded gasoline, some types of industrial facilities, and past use of lead-based paint in homes. Lead and lead compounds have been used in a wide variety of products found in and around our homes, including paint, ceramics, pipes and plumbing materials, solders, gasoline, batteries, ammunition, and cosmetics.

Lead may enter the environment from these past and current uses. Lead can also be emitted into the environment from industrial sources and contaminated sites, such as former lead smelters. While natural levels of lead in soil range between 50 and 400 parts per million, mining, smelting, and refining activities have resulted in substantial increases in lead levels in the environment, especially near mining and smelting sites.

When lead is released to the air from industrial sources or spark-ignition engine aircraft, it may travel long distances before settling to the ground, where it usually sticks to soil particles. Lead may move from soil into ground water depending on the type of lead compound and the characteristics of the soil.

Federal and state regulatory standards have helped to reduce the amount of lead in air, drinking water, soil, consumer products, food, and occupational settings.

Who is at Risk?

Children

Lead is particularly dangerous to children because their growing bodies absorb more lead than adults do and their brains and nervous systems are more sensitive to the damaging effects of lead. Babies and young children can also be more highly exposed to lead because they often put their hands and other objects that can have lead from dust or soil on them into their mouths. Children may also be exposed to lead by eating and drinking food or water containing lead or from dishes or glasses that contain lead, inhaling lead dust from lead-based paint or lead-contaminated soil or from playing with toys with lead paint.

Adults, Including Pregnant Women

Adults may be exposed to lead by eating and drinking food or water containing lead or from dishes or glasses that contain lead. They may also breath lead dust by spending time in areas where lead-based paint is deteriorating, and during renovation or repair work that disturbs painted surfaces in older homes and buildings. Working in a job or engaging in hobbies where lead is used, such as making stained glass, can increase exposure as can certain folk remedies containing lead. A pregnant woman’s exposure to lead from these sources is of particular concern because it can result in exposure to her developing baby.

Lead Exposure Data

The U.S. Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics monitors blood lead levels in the United States. Get information on the number of children with elevated blood lead levels, and number and percentage of children tested for lead in your area.

According to CDC

• The most important step parents, doctors, and others can take is to prevent lead exposure before it occurs.
• Until recently, children were identified as having a blood lead level of concern if the test result is 10 or more micrograms per deciliter of lead in blood. Experts now use a new level based on the U.S. population of children ages 1-5 years who are in the top 2.5% of children when tested for lead in their blood (when compared to children who are exposed to more lead than most children). Currently that is 5 micrograms per deciliter of lead in blood. The new, lower value means that more children likely will be identified as having lead exposure allowing parents, doctors, public health officials, and communities to take action earlier to reduce the child’s future exposure to lead.

What are the Health Effects of Lead?

Lead can affect almost every organ and system in your body. Children six years old and younger are most susceptible to the effects of lead.

Children

Even low levels of lead in the blood of children can result in:

• Behavior and learning problems
• Lower IQ and Hyperactivity
• Slowed growth
• Hearing Problems
• Anemia

In rare cases, ingestion of lead can cause seizures, coma and even death.

Pregnant Women

Lead can accumulate in our bodies over time, where it is stored in bones along with calcium. During pregnancy, lead is released from the mother's bones along with calcium and can pass from the mother exposing the fetus or the breastfeeding infant to lead. This can result in serious effects to the developing fetus and infant, including:

• Cause the baby to be born too early or too small;
• Hurt the baby’s brain, kidney’s, and nervous system;
• Increase the likelihood of learning or behavioral problems; and
• Put the mother at risk for miscarriage.

Find out more about lead's effects on pregnancy and lactating women:

• Effects of Workplace Hazards on Female Reproductive Health, National Institute for Occupational Safety and Health (PDF) (23 pp, 292 KB)
• Guidelines for the Identification and Management of Lead Exposure in Pregnant and lactating Women, National Center for Environmental Health (PDF)(302 pp, 4.2 MB).

Other Adults

Lead is also harmful to other adults. Adults exposed to lead can suffer from:

• Cardiovascular effects, increased blood pressure and incidence of hypertension
• Decreased kidney function
• Reproductive problems (in both men and women)

Lower Your Chances of Exposure to Lead

Simple steps like keeping your home clean and well-maintained will go a long way in preventing lead exposure. You can lower the chances of exposure to lead in your home, both now and in the future, by taking these steps:

• Inspect and maintain all painted surfaces to prevent paint deterioration
• Address water damage quickly and completely
• Keep your home clean and dust-free
• Clean around painted areas where friction can generate dust, such as doors, windows, and drawers. Wipe these areas with a wet sponge or rag to remove paint chips or dust
• Use only cold water to prepare food and drinks
• Flush water outlets used for drinking or food preparation
• Clean debris out of outlet screens or faucet aerators on a regular basis
• Wash children's hands, bottles, pacifiers and toys often
• Teach children to wipe and remove their shoes and wash hands after playing outdoors
• Ensure that your family members eat well-balanced meals. Children with healthy diets absorb less lead.
• If you are having home renovation, repairs, or painting done, make sure your contractor is Lead-Safe Certified, and make sure they follow lead safe work practices

What do I do if I think my child or I have been exposed to lead?

Talk to your pediatrician, general physician, or local health agency about what you can do. Your doctor can do a simple blood test to check you or your child for lead exposure. You may also want to test your home for sources of lead.

Lead is sometimes found in certain foods, cosmetics, and traditional medicines imported from other countries.

How you or your child may be exposed

Lead has been found in some candies imported from Mexico. Certain candy ingredients such as chili powder and tamarind may be a source of lead exposure. Lead can get into the candy when drying, storing, and grinding the ingredients are done improperly. Ink from plastic or paper candy wrappers may also contain lead that leaches or seeps into the imported candy. Lead has also been found in certain spices imported from Vietnam, India, and Syria among other countries.

Lead has been found in powders and tablets given for arthritis, infertility, upset stomach, menstrual cramps, colic, and other illnesses traditionally used by East Indian, Indian, Middle Eastern, West Asian, and Hispanic cultures. Traditional medicines can contain herbs, minerals, metals, or animal products that are thought to be useful in treating some ailments. Lead and other heavy metals may be added or accidentally get into the products during grinding, during coloring, or from the package.

Lead has also been found in products typically used as cosmetics or in religious ceremonies. Children and adults have become lead poisoned by ingesting a product generically called “sindoor.” Though not intended to be food, sindoor might be used by some as a food additive. Traditionally, Hindu, and some Sikh, married women wear the red sindoor powder in the parting of their hair to indicate marital status.

You cannot tell if a food, candy, spice, medicine or cosmetic contains lead by looking at or tasting it. People selling these products may not know if the products contain lead. Consuming even small amounts of lead can be harmful and lead poisoning from these items can cause illness or death.

You only can tell for sure if certain foods, candies, spices, cosmetics, and traditional medicines or ceremonial powders contain lead by having them tested in a laboratory. It is best to avoid the use of products that may contain lead.

Some items known to contain lead

Ba-baw-san is a Chinese herbal remedy that contains lead. It is used to treat colic pain or to pacify young children.

Daw Tway is a digestive aid used in Thailand and Myanmar (Burma). Analysis of Daw Tway samples showed them to contain as much as 970 parts per million (ppm) of lead.

Greta and Azarcon (also known as alarcon, coral, luiga, maria luisa, or rueda) are Hispanic traditional medicines taken for an upset stomach (empacho), constipation, diarrhea, and vomiting. They are also used on teething babies. Greta and Azarcon are both fine orange powders with lead content as high as 90%.

Ghasard, an Indian folk medicine, has also been found to contain lead. It is a brown powder used as a tonic.

Sindoor. Testing of the Swad brand sindoor product found that it contained very high levels of lead, sometimes as high as 87%.

What to do if you think you or your child has been exposed

If you think that you or your child has been exposed to lead in food, candy, spices, cosmetics, or traditional medicines, contact your health care provider. Most children and adults who are exposed to lead have no symptoms. The only way to tell if you or your child has been exposed is with a blood lead test. Your health care provider can help you decide whether a blood lead test is needed and can also recommend appropriate follow-up actions if you or your child has been exposed. As levels of lead in the blood increase, adverse effects from lead may also increase.

The most common sources of lead in drinking water are lead pipes, faucets, and plumbing fixtures. Certain pipes that carry drinking water from the water source to the home may contain lead. Household plumbing fixtures, welding solder, and pipe fittings made prior to 1986 may also contain lead.

How lead gets into tap water

Steps taken during the last two decades have reduced exposures to lead in tap water. These steps include actions taken under requirements of the 1986 and 1996 amendments to the Safe Drinking Water Act and the U.S. Environmental Protection Agency’s (EPA’s) Lead and Copper Rule. Even so, lead in water can come from homes with lead service lines that connect the home to the main water line. Homes without lead service lines may still have brass or chrome-plated brass faucets, galvanized iron pipes or other plumbing soldered with lead. Some drinking water fountains with lead-lined tanks and other plumbing fixtures not intended for drinking water (e.g., lab faucets, hoses, spigots, hand washing sinks) may also have lead in the water.

Lead can enter drinking water when a chemical reaction occurs in plumbing materials that contain lead. This is known as corrosion – dissolving or wearing away of metal from the pipes and fixtures. This reaction is more severe when water has high acidity or low mineral content. How much lead enters the water is related to:

• the acidity or alkalinity of the water,
• the types and amounts of minerals in the water,
• the amount of lead that water comes into contact with,
• the water temperature,
• the amount of wear in the pipes,
• how long the water stays in pipes, and
• the presence of protective scales or coatings in the pipes.

How to find out if my tap water is contaminated with lead

You cannot see, taste, or smell lead in drinking water. The best way to know your risk of exposure to lead in drinking water is to identify the potential sources of lead in your service line and household plumbing.

Ask your water provider if you have a lead service line providing water to your home. If you have a lead service line, ask if there are any programs to assist with removal of the lead service line going to your home. Understand that any work, such as water main or service line replacement, could increase exposure to lead while the work is ongoing and for up to six months after the work is completed.

Ask to have your water tested. Many public water systems will test drinking water for residents upon request. There are also laboratories that are certified to test for lead in water. Understand that water sampling results can vary depending on the time of day, season, method of sampling, flow of water and other factors.

More information is available at National Lead Laboratory Accreditation Program List and Contact Information for Certification Programs and Certified Laboratories for Drinking Water.

Risk from lead in water

Because no safe blood level has been identified for young children, all sources of lead exposure for children should be controlled or eliminated. EPA has set the maximum contaminant level goal for lead in drinking water at zero because lead can be harmful to human health even at low exposure levels. Lead is a toxic metal that is persistent in the environment and can accumulate in the body over time. Risk will vary depending on the individual, the chemical conditions of the water, and the amount consumed. For example, infants who drink formula prepared with lead-contaminated tap water may be at a higher risk of exposure because of the large volume of water they consume relative to their body size. Bathing and showering should be safe for you and your children because human skin does not absorb lead in water.

What to do if you think you or your child has been exposed

If you think that you or your child has been exposed to lead in water, contact your health care provider. Most children and adults who are exposed to lead have no symptoms. The best way to tell if you or your child has been exposed is with a blood lead test. Your health care provider can help you decide whether a blood lead test is needed and can also recommend appropriate follow-up actions if you or your child has been exposed. As levels of lead in the blood increase, adverse effects from lead may also increase.

How to reduce or eliminate exposure to lead in tap water

If you are concerned about lead in water or know that your plumbing contains lead, you can take action to reduce the amount of lead in your drinking water and minimize your potential for exposure.

• You can reduce or eliminate your exposure to lead in tap water by drinking or using only tap water that has been run through a “point-of-use” filter certified by an independent testing organization to reduce or eliminate lead (NSF/ANSI standard 53 for lead removal and NSF/ANSI standard 42 for particulate removal). If you have a lead service line, use a filter for all water you use for drinking or cooking.
• You can flush your water to reduce potential exposure to lead from household lead plumbing. This is especially important when the water has been off and sitting in the pipes for more than 6 hours. Before drinking, flush your home’s pipes by running the tap, taking a shower, doing laundry, or doing a load of dishes. The amount of time to run the water will depend on whether your home has a lead service line or not, and the length of the lead service line. Drink or cook only with water that comes out of the tap cold. Water that comes out of the tap warm or hot can have higher levels of lead. Boiling this water will not reduce the amount of lead in your water.
• You can virtually eliminate your exposure to lead in water by drinking or using only bottled water that has been certified by an independent testing organization. This may not be the most cost-effective option for long-term use.

Protecting children from exposure to lead is important to lifelong good health. No safe blood lead level in children has been identified. Even low levels of lead in blood have been shown to negatively affect a child’s intelligence, ability to pay attention, and academic achievement. While the effects of lead poisoning are permanent, if caught early, there are things parents can do to prevent further exposure and reduce damage to their child’s health.

Lead exposure occurs when a child comes in contact with lead by touching, swallowing, or breathing in lead or lead dust.

Exposure to lead can seriously harm a child’s health and cause well-documented adverse effects such as:

• Damage to the brain and nervous system
• Slowed growth and development
• Learning and behavior problems
• Hearing and speech problems

This can cause:

• Lower IQ
• Decreased ability to pay attention
• Underperformance in school

There is also evidence that childhood exposure to lead can cause long-term harm.

Lead exposure in children is often difficult to see. Most children have no obvious immediate symptoms. If there’s suspicion that a child may have been exposed to lead, parents should talk to their child’s healthcare provider about getting a blood lead test. Healthcare providers and most local health departments can test for lead in the blood. Many private insurance policies cover the cost of testing for lead in the blood. The cost of blood lead testing for children enrolled in Medicaid is covered by the Centers for Medicare & Medicaid services.

The health effects of exposure are more harmful to children less than six years of age because their bodies are still developing and growing rapidly. Young children also tend to put their hands or other objects, which may be contaminated with lead dust, into their mouths, so they are more likely to be exposed to lead than older children.

Lead in the Blood and Body

Lead quickly enters the blood and can harm a child’s health. Once a child swallows lead, their blood lead level rises. Once a child’s exposure to lead stops, the amount of lead in the blood decreases gradually. The child’s body releases some of the lead through urine, sweat, and feces. Lead is also stored in bones. It can take decades for lead stored in the bones to decrease.

Many things affect how a child’s body handles exposure to lead, including the following:

• Child’s age
• Nutritional status
• Source of lead exposure
• Length of time the child was exposed
• Presence of other underlying health conditions

Although lead in blood represents only a portion of the total amount of lead present in the body, a blood lead test is the easiest way to assess a person’s exposure to lead.

Prevent Lead Exposure

The good news is that childhood lead exposure is preventable. The most important step that parents, healthcare providers, and others can take is to prevent exposure.

Across the United States, there are a variety of childhood lead exposure sources and risk factors.

Children from low-income households and those who live in housing built before 1978 are at the greatest risk of lead exposure. Houses built before 1978, the time before the use of lead in paint was banned, and houses in low-income areas, many of which have homes built before 1978, are more likely to contain lead-based paint and have pipes, faucets, and plumbing fixtures containing lead. Also, some African American persons are at a higher risk of lead exposure due to poor housing stock.

Children less than six years old are at a higher risk of lead exposure. This is because their bodies are rapidly developing and more susceptible to taking in lead if exposed. Young children also tend to put their hands or other objects into their mouths. This is why the most common source of lead exposure in young children is lead dust that they swallow after placing their lead-contaminated hands or other objects in their mouths.

Immigrant and refugee children from less developed countries are at higher risk of being exposed to lead due to less strict rules protecting children from lead exposure, in their country of origin. Because of this, children who are immigrants, refugees, or recently adopted from less developed countries are also at risk for lead exposure.

Pregnant people should know the risk of lead exposure because lead can pass to their baby during pregnancy. Breastfeeding can also be a source of lead exposure to babies. Adults who are or have been exposed to lead can also pass lead to their babies when breastfeeding. Formula prepared using water contaminated with lead from leaded pipes and plumbing parts can also result in a baby being exposed to lead.

Some adults work in industries or have hobbies that expose them to lead. These adults may bring lead home with them and expose their families to lead without knowing. For example, a parent who works in battery manufacturing or renovation of older homes could bring home lead dust on their clothes, shoes, skin, hair, and hands. This dust can be tracked onto carpets, floors, furniture, and other surfaces that a child may touch. Adults who are exposed to lead in their workplace or from hobbies should take steps to keep them and their families safe from lead.

Children under the age of 6 are at greatest risk for health problems caused by lead exposure. The health effects of lead exposure are more harmful to younger children than older children and adults because their bodies are still developing, and they are growing so rapidly. Young children also tend to put their hands or other objects, which may be contaminated with lead dust, into their mouths.

Children can be exposed to lead from many sources, including:

• Paint in homes built before 1978 that is deteriorating or chipping.
• Soil near older buildings, airports, or busy roads.
• Drinking water delivered through lead pipes, faucets, and plumbing fixtures.
• Consumer products, such as toys, jewelry, antiques, and collectible items.
• Certain foods, cosmetics, and traditional medicines imported from other countries.
• Jobs and hobbies that involve working with lead-based products and might cause parents or caregivers to bring lead into the home.

Though lead can be found in many places in a child’s environment, lead exposure is preventable. The key is stopping children from coming into contact with lead by touching, swallowing, or breathing in lead or lead dust. Parents can take steps to make their homes more lead safe.

Exposure to lead can seriously harm a child’s health and cause well-documented health effects, including damage to the brain and nervous system, slowed growth and development, learning and behavior problems, and hearing and speech problems. If your child may have been exposed to lead, talk to your child’s health care provider about getting a blood lead test.

Lead can pass from a parent to their unborn baby. The good news is that lead exposure is preventable. Now is the time to keep your baby safe from lead poisoning.

If an adult has been exposed to lead over a long time or has had high levels of lead in their blood in the past, the lead stored in their bones can be released into the blood during pregnancy. This means that the level of lead in their blood can start to increase during pregnancy. If a person is exposed to lead during their pregnancy, their developing baby can also be exposed.

Lead in the blood during pregnancy can:

• Increase risk for miscarriage
• Cause the baby to be born too early or too small
• Hurt the baby’s brain, kidneys, and nervous system
• Cause the child to have learning or behavior problems

If you are pregnant and think you may have been exposed to lead, talk to your healthcare provider about getting a blood lead test. A blood test is the best and most readily available way to determine if you have been exposed to lead. Based on your blood lead test result, your doctor may recommend finding and removing lead from your environment, eating a diet high in iron and calcium, and scheduling follow-up blood lead testing.

Protecting children from exposure to lead is important for lifelong good health. No safe blood lead level has been identified. Even low levels of lead in blood have been shown to affect IQ, ability to pay attention, and academic achievement. The effects of lead exposure cannot be corrected.

How Might Lead Affect Breastfeeding Mothers and Infants?

Women who have been or are currently exposed to lead can expose their fetus or infant to lead during pregnancy and lactation through blood and breast milk, which can have long-term effects on the neurodevelopment of their child. During pregnancy and lactation, mothers can have lead in their blood or breast milk for two reasons:

1. They have been directly exposed to lead during pregnancy or lactation.
2. Lead that is stored in a woman’s bones and teeth from a prior exposure to lead can be released during pregnancy or lactation.

Can Mothers Breastfeed Their Children If They Have Elevated Blood Lead Levels (BLLs)?

If a pregnant or lactating woman has blood lead levels (BLLs) ≥5 μg/dL, the health care provider should attempt to determine the source(s) of lead exposure, working with the local health department and occupational medicine specialists as needed for environmental assessment and case management.

It is recommended that mothers with BLLs 40 μg/dL should breastfeed, but it is important to note:

• Infant BLLs should be monitored if his or her mother’s BLLs are between 5 and 39 μg/dL. Breastfeeding should continue for all infants with BLLs below 5 μg/dL.
• If infant BLLs are rising or failing to decline by 5 μg/dL or more, the healthcare provider should contact the local health department for environmental sampling. If no external source is identified, and maternal BLLs are ≥20 μg/dL and infant BLLs are ≥5 μg/dL, then breast milk may be the source of lead exposure. Mothers should consider temporarily pumping and discarding their breast milk until maternal BLLs are lower.

Mothers with BLLs ≥40 μg/dL are encouraged to pump and discard their milk until their BLLs drop below 40 µg/dL.

• Testing breast milk for lead is not recommended.

What Are Some Kinds of Lead Hazards Breastfeeding Women Might Be Exposed To? How Can They Protect Themselves and Their Infants?

Breastfeeding women should be aware of or avoid the following:

• Lead-based paint (typically found in homes built before 1978). Stay away from repair, repainting, renovation, and remodeling work. Test paint before starting home improvements that disturb paint. If hiring someone else to perform work, make sure they follow lead paint repair rules from the Environmental Protection Agency (EPA).
• Pica. Never eat or mouth clay, soil, pottery, or paint chips because they may be contaminated with lead.
• Tainted food. Use caution when eating candies, spices, food additives, and other foods from abroad, especially if they appear to be noncommercial products of unknown safety. Limit eating game meat—such as deer—that have been hunted with lead ammunition.
• Tainted foodware. Avoid using imported lead-glazed ceramic pottery and pewter or brass containers or utensils to cook, serve, or store food. Avoid using leaded crystal to serve or store beverages. Do not use dishes that are chipped or cracked.
• Tainted medicine or personal care products. Avoid imported medicines and herbal remedies (azarcon, Ayurvedics); cosmetics and ceremonial powders (tiro, kohl, kajal, surma); and personal care products (litargirio) that may contain lead.
• Water with lead levels exceeding 15 parts per billion (ppb). If water lead levels exceed EPA’s action level of 15 ppb, use bottled water or water from a filtration system certified by an independent testing organization to reduce or eliminate lead for cooking and drinking.
• Some occupations or hobbies that may involve lead exposure. These include construction or home renovation/repair in pre-1978 homes; firing ranges and military or police work; battery or electronics manufacturing or recycling; soldering or casting metal; oil field work; mining; and aviation gas used in small planes. If a household member works with lead, take precautions to avoid taking home lead dust in cars or on clothing, skin, hair, and shoes.
• Prior exposure. Prior significant exposure such as childhood environmental exposure or previous occupational exposure could lead to large stores of lead in bone which can become mobilized during pregnancy.
• Recent immigration. Recent immigration to the United States from countries where relatively high lead exposure is endemic, such as countries where leaded gasoline is still used or where use of consumer products containing lead is widespread.

Prospective parents adopting a child from overseas need information to safeguard the health of the child. This webpage contains information for adopting parents, adoption service providers, and health care providers.

The U.S. Department of State records show that from October 1, 2018 to September 30, 2019, a total of 2,971 children who have been adopted from other countries immigrated to the United States. The largest numbers of these children were originally from mainland China (819), Colombia (244), India (241), South Korea (166), and Ukraine (298). The risk for lead exposure is much higher in many countries from which children are adopted than in the United States. Each country sets its own policies on regulations for environmental exposures, and some countries have stronger regulations than others.

Main sources of exposure to lead differ from country to country
Children’s exposure to sources of lead varies by country. Even within a country, lead exposure may vary by racial/ethnic group or income level. In the United States, lead-based paint and lead-contaminated dust and soil are the primary sources of childhood-lead exposure.

Children from outside the United States can be exposed to lead from

• Ceramic or metal dishes or pots used for cooking or eating,
• Contamination from living with a person who is exposed on the job,
• Contamination from nearby mining and smelting,
• Cosmetics,
• Cottage industries (e.g., breaking up batteries or metal ore),
• Drinking water from metal pipes or metal storage containers,
• Food, spices, and candies (from the ingredients or the packaging),
• Industrial emissions, and
• Traditional medicines

Risk for elevated blood lead levels
No safe blood lead level for children has been identified. Because lead exposure often occurs with no obvious symptoms, it frequently goes unrecognized. In 2021, the Centers for Disease Control and Prevention (CDC) adopted use of the blood lead reference value (BLRV) of 3.5 μg/dL or higher based on recommendations from CDC’s federal advisory committee made up of experts in the field. The CDC BLRV is based on the U.S. population of children ages 1-5 years who represent those at the top 2.5% with the highest blood lead levels. Evidence exists that lead in the body, even at low levels, can cause health problems and affect a child’s behavior or how they learn in school. At very high levels, in extreme cases, it can cause seizures or death.

Parents or Prospective Parents of Children who have been Adopted

Why should I be concerned?
Concern exists about children adopted from overseas who may have been exposed to lead before they came to the United States. Recently in the United States, a small number of children who have been adopted from other countries have been found to have high levels of lead in their bodies.

As a group, children who have been adopted from other countries tend to have higher levels of lead in their blood than children born in the United States. Children can be exposed to lead in different ways in countries.

How do I know if my child was exposed to lead?
Most children with lead in their blood do not have any symptoms. The only way to know for sure is to have your child tested with a blood test.

How can I check for lead in my child?
Ask your child’s doctor to test your child for lead in their blood. You may want to contact your state or local Childhood Lead Poisoning Prevention Program.

Who can I contact for blood lead testing or other information about the health of my child who has been adopted from another country?
You can contact either your doctor or your local health department if you have concerns about lead in your child’s blood or other health concerns.

The American Academy of Pediatrics provides recommendations on comprehensive health evaluations for all children who have been newly adopted.

Intercountry Adoption Service Providers

Adoption service providers play an important role in increasing awareness of lead exposure among children who have been adopted from other countries. Under current regulations and routine practice, blood lead levels among foreign-born children may not be detected.

Adopting parents lack information on the hazards of lead exposure that could help them improve their children’s growth, development, and prospects for the future.

It is important that adoption service providers provide lead-exposure fact sheets with health information, including information on accessible testing sites, to prospective parents.

Adoption service providers should also encourage adopting parents and doctors to test foreign-born children for lead exposure when they arrive in the United States.

Health Care Providers

International Childhood Lead Exposure
Children immigrating to the United States through intercountry adoptions have health issues as diverse as the cultures into which they were born. Although recent research is sparse, evidence suggests that a significant proportion of immigrant children and children who have been adopted from other countries have been exposed to lead. Risk for lead exposure varies by country of origin. According to one study, 40% of children from Cuba and Haiti, 37% from Asia, 27% from Vietnam and Africa, and 25% from the Near East had blood lead levels. Overall, approximately 11.3% of children who have been adopted from other countries have blood lead levels ≥10 micrograms per deciliter.

Medical Testing before Immigration to United States
Blood lead testing is not required before immigration to the United States. Before arrival in the United States, all immigrants are required to have a medical examination in their country of origin by a physician approved by the local U.S. embassy or consulate. This medical examination focuses primarily on detecting serious disabilities and contagious diseases.

Recommendations for Screening and Medical Management of Children with Elevated Blood Lead Levels
Screening for blood lead level is recommended upon arrival to the United States and at 12 and 24 months of age. Physicians should follow their state and local guidelines on health screening of children living in conditions that place them at a high risk for lead exposure. Children who have been adopted from other countries are considered high risk for lead exposure. You can also contact the Childhood Lead Poisoning Prevention Program in your state for additional information.

Lead poisoning disproportionately impacts refugee and other newcomer children resettled in the United States. Refugee children arriving in the United States have higher blood lead levels (BLL) than U.S.-born children, though this varies among sub-populations.

Reports suggest that country of origin and country of last residence are strong predictors of elevated BLLs among refugee children. Furthermore, in some circumstances these children may experience a rise in BLLs after arriving and resettling in the United States.

Causes and Risk Factors

Several risk factors put newcomer children who are resettled in the U.S. at a higher risk for lead exposure. These include

Environmental exposure. Newcomer children may be exposed to environmental lead hazards in their country of origin. These hazards include industrial emissions, lead-based paint, and the burning of waste containing lead.

Newcomer children may be exposed to environmental lead hazards from:

• Living near or working in mines, ammunition manufacturing, smelters, or battery recycling facilities.
• Lead-based paint and leaded gasoline have only been recently phased out in much of the world. Newcomer children may currently or have previously lived in areas where high lead levels remain in the soil even in areas where leaded gasoline is no longer widely used.
• Resettling in pre-1978 housing containing lead-based paint after arriving to the U.S.

Cultural practices, traditional medicines, and consumer products. Some cultural practices, traditional medicines, and household and personal use items are associated with increased BLLs, before and after U.S. arrival.

• Refugees and other newcomer populations may use or consume imported products contaminated with lead, such as traditional remedies, herbal supplements, spices, candies with lead in the wrappers, cosmetics, jewelry, and amulets.
• Car batteries used for household electricity outside the U.S., lead-glazed pottery, pewter or brass utensils or cooking pots, pressure cookers, leaded crystal, and chipped or cracked dishes may also be sources of lead exposure.

Other risk factors. Parents of newcomer children may not know about the risks posed by lead exposure and may not recognize potential sources in their daily lives. Most children with lead in their blood may not have any obvious immediate symptoms. Newcomer children are also more likely to have compromised nutritional status. This includes chronic malnutrition and other moderate to severe health conditions that could increase lead absorption and possible neurological effects.

While some of the above information pertains specifically to refugees, many of these risk factors will be similar for all children arriving from the same countries or regions, regardless of visa type.

Lead Screening Recommendations

Refugees and eligible newcomers receive a range of benefits and services such as a comprehensive domestic medical examination within 90 days of arrival to the United States that screens for a wide range of infectious diseases and non-communicable conditions. As part of the domestic medical screening, healthcare providers might consider evaluating refugee and other eligible newcomer children and pregnant/lactating women for lead exposure, with follow-up testing for specific age groups.

For CDC’s lead screening recommendations for refugees and certain other newcomer infants, children, adolescents, and pregnant and lactating women and girls, refer to Screening for Lead during the Domestic Medical Examination for Newly Arrived Refugees. This guidance was developed by the Immigrant, Refugee, and Migrant Health Branch in collaboration with its Centers of Excellence in Newcomer Health, and external experts in refugee health.

Certain jobs and industries are more likely to come in contact with lead.

These jobs have been known to put workers at risk of lead exposure:

• Artists (materials used may contain lead)
• Auto repairers (car parts may contain lead)
• Battery manufacturers (batteries contain lead)
• Bridge reconstruction workers (old paint may contain lead)
• Construction workers (materials used may include lead)
• Firing range instructors and gunsmiths (ammunition contains lead)
• Glass manufacturers (lead may be used in glass production)
• Lead manufacturers
• Lead miners
• Lead refiners
• Lead smelters
• Manufacturers of bullets, ceramics, and electrical components (all contain lead)
• Painters (old paint and commercial paint may contain lead)
• Plastic manufacturers (materials made may contain lead)
• Plumbers and pipe fitters (pipes may contain lead)
• Police officers (ammunition contains lead)
• Radiator repairers (radiators may contain lead)
• Recyclers of metal, electronics, and batteries (may contain lead)
• Rubber product manufacturers (process contains lead)
• Shipbuilders (materials used may include lead)
• Solid waste incinerator operators (waste may contain lead)
• Steel welder (galvanized steel is coated in part with lead)

CDC recommends testing blood for lead exposure. There are often no apparent symptoms when a child is exposed to lead. Because of this, a blood test is the easiest way to determine if a child has been exposed to lead. If your child may have been exposed to lead, talk to your healthcare provider about getting a blood lead test. Based on your child’s blood lead test results, healthcare providers can recommend follow-up actions and care.

Testing Blood Lead Levels

During a blood lead test, a small amount of blood is taken from the finger, heel, or arm and tested for lead. Two types of blood tests may be used.

• A finger-prick or heel-prick (capillary) test is usually the first step to determine if a child has lead in their blood. While finger-prick tests can provide fast results, they also can produce higher results if lead on the skin is captured in the sample. For this reason, a finger-prick test that shows a blood lead level at or above the CDC’s blood lead reference value is usually followed by a second test to confirm.
• A venous blood draw takes blood from the child’s vein. This type of test can take a few days to receive results and is often used to confirm blood lead levels seen in the first capillary test.

Most children with any lead in their blood have no obvious immediate symptoms. If a child may have been exposed to lead, parents should talk to their child’s health care provider about getting a blood lead test. Healthcare providers and most local health departments can test for lead in the blood. Many private insurance policies cover the cost of testing for lead in the blood. The cost of blood lead testing for children enrolled in Medicaid is covered by the Centers for Medicare & Medicaid services.

Treating Children Based on Their Blood Lead Levels

If a child has lead in their blood above the CDC blood lead reference value, their doctor may recommend follow-up services. These include finding and removing lead from the child’s environment, feeding the child a diet high in iron and calcium, connecting the child to early educational services, and scheduling follow-up blood testing. Early identification of lead in the blood is key to reducing the long-term effects of lead exposure.

If a child has very high levels of lead in their blood, health care providers may recommend other types of testing and treatment to remove some of the lead from the blood. This may include getting an x-ray to determine if they have high levels of lead in their blood. If a child does have high levels of lead in their blood, they may receive chelation therapy, which is a medical treatment used to remove lead from the body.

Blood Lead Reference Value

The amount of lead in blood is referred to as the blood lead level, which is measured in micrograms of lead per deciliter of blood (μg/dL). CDC currently uses a blood lead reference value of 3.5 micrograms per deciliter 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 are among the top 2.5% of U.S. children with the highest blood lead levels.

Preventing Childhood Lead Exposure

Though lead can be found in many places in a child’s environment, lead exposure is preventable. The key is stopping children from coming into contact with lead. Parents can take simple steps to make their homes more lead-safe.

Lead from paint, dust and soil in and around your home can be dangerous if not managed properly.

Older Homes and Buildings

If your home was built before 1978, it is more likely to have lead-based paint. In 1978, the federal government banned consumer uses of lead-based paint, but some states banned it even earlier.

Lead paint is still present in millions of homes, sometimes under layers of newer paint. If the paint is in good shape, the lead paint is usually not a problem. Deteriorating lead-based paint (peeling, chipping, chalking, cracking, damaged, or damp) is a hazard and needs immediate attention.

Lead-based paint may also be a hazard when found on surfaces that children can chew or that get a lot of wear-and-tear, such as:

• Windows and window sills;
• Doors and door frames; and
• Stairs, railings, banisters, and porches.

A few tips to reduce sources of lead exposure in older homes and buildings:

• Inspect and keep all painted surfaces in excellent shape and clean up dust frequently with a wet cloth or paper towel.
• Consult a certified lead professional before beginning renovation, repair or painting projects. Renovation, repair or painting activities can create toxic lead dust when painted surfaces are disturbed or demolished.
• Avoid tracking lead dust into the home by wiping and removing shoes before entering the home and placing dust mats both inside and outside of entryways.
• Learn if you have a lead service line. Contact your water utility or a licensed plumber to determine if the pipe that connects your home to the water main (called a service line) is made from lead.

Soil, Yards and Playgrounds

Soil, yards and playgrounds can become contaminated when exterior lead-based paint from houses or buildings flakes or peels and gets into the soil. Soil may also be contaminated from past use of leaded gasoline in cars, from industrial sources, or even from contaminated sites, including former lead smelters. Lead is also naturally occurring and it can be found in high concentrations in some areas.

Lead in soil can be ingested as a result of hand-to-mouth activity that is common for young children and from eating vegetables that may have taken up lead from soil in the garden. Lead in soil may also be inhaled if resuspended in the air or tracked into your house thereby spreading the contamination.

Older playground equipment can still contain old lead-based paint, and artificial turf and playground surfaces made from shredded rubber can contain lead. Take precautions to ensure young children do not eat shredded rubber or put their hands in their mouth before washing them.

To reduce exposures to lead from soils, yards and playgrounds:

• Check the exterior of your home, including porches and fences, for flaking or deteriorating lead-based paint that may contaminate soil in your yard or be tracked into your house.

• Put doormats outside and inside all entryways and remove your shoes before entering to avoid tracking contaminated soil into your house.

• Wash hands several times a day using soap and water, especially after playing or working outside.

• Plant bushes close to the house to keep children from playing in soil near your home.

Dust

Lead in household dust results from indoor sources such as old lead-based paint on surfaces that are frequently in motion or bump or rub together (such as window frames), deteriorating old lead-based paint on any surface, home repair activities, tracking lead-contaminated soil from the outdoors into the indoor environment, or even from lead dust on clothing worn at a job site.

Even in well-maintained homes, lead dust can form when lead-based paint is scraped, sanded or heated during home repair activities. Lead paint chips and dust can get on surfaces and objects that people touch. Settled lead dust can re-enter the air when the home is vacuumed or swept, or people walk through it.

To reduce exposure to lead dust, it is especially important to:

• Maintain all painted surfaces in good condition.

• Clean frequently using a wet mop, cloth or sponge to reduce the likelihood of chips and dust forming.

• Use a lead-safe certified renovator to perform renovation, repair and painting jobs to reduce the likelihood of contaminating your home with lead dust.

Products

Lead has been used for a long time in a wide variety of products found in and around our homes, including painted toys, furniture and toy jewelry; cosmetics; food or liquid containers; and plumbing materials.

That favorite dump truck or rocking chair handed down in the family, antique doll furniture or toy jewelry could contain lead or lead-based paint. The Consumer Product Safety Commission (CPSC) has a comprehensive program on lead in toys including toy jewelry. Biting or swallowing toys or toy jewelry that contain lead can cause a child to suffer from lead poisoning. To help protect against that risk, CPSC has put protections in place that ban the use of lead in many children’s products. For example:

• In 2004, the threat of lead poisoning from toy jewelry led the CPSC to conduct a voluntary recall of 150 million pieces of metal toy jewelry sold widely in vending machines.
• In 2007, CPSC issued a press release announcing the Fisher-Price recall of 967,000 toys due to lead poisoning hazard.
• Toy jewelry containing unsafe levels of lead has continued to be sold even after CPSC issued guidance to prevent the sale of these products. Other products containing lead have also been recalled, such as crayons, chalk, clothing and children’s products painted with lead-based paint.
• CPSC has evaluated whether commercially available lead test kits reliably and accurately detect the presence or absence of lead in consumer products, such as toy jewelry and children's vinyl toys. Based on this evaluation, CPSC does not recommend that these test kits be used for consumer products.

The Food and Drug Administration (FDA) recommends a maximum level of lead in cosmetic products.

Food and liquids stored or served in lead crystal or lead-glazed pottery or porcelain can become contaminated because lead can leach from these containers into the food or liquid.

Drinking Water

Lead can enter drinking water through corrosion of plumbing materials, especially where the water has high acidity or low mineral content that corrodes pipes and fixtures. Homes built before 1986 are more likely to have lead pipes, fixtures and solder.

In 2011, changes to the Safe Drinking Water Act reduced the maximum allowable lead content to be a weighted average of 0.25 percent calculated across the wetted surface of pipes, pipe fittings, plumbing fittings and fixtures and 0.2 percent for solder and flux. The most common problem is with brass or chrome-plated brass faucets and fixtures with lead solder.

Corrosion is a dissolving or wearing away of metal caused by a chemical reaction between water and your plumbing. A number of factors are involved in the extent to which lead enters the water including the chemistry of the water (acidity and alkalinity), the amount of lead it comes into contact with, how long the water stays in the plumbing materials and the presence of protective scales or coatings inside the plumbing materials. To address corrosion of lead and copper into drinking water, EPA issued the Lead and Copper Rule (LCR) under the authority of the Safe Drinking Water Act. One requirement of the LCR is corrosion control treatment to prevent lead and copper from contaminating drinking water. Corrosion control treatment means utilities must make drinking water less corrosive to the materials it comes into contact with on its way to consumers' taps.

Jobs and Hobbies

Working with lead and/or lead-based paint (e.g., renovation and painting, mining, smelting, battery recycling, refinishing old furniture, autobody, shooting ranges); or having a hobby that uses lead (e.g., hunting, fishing, stained glass, stock cars, making pottery) could cause you to bring lead home on your hands or clothes, or contaminate your home directly. Lead can be found in hunting ammunition, fishing tackle, came and solder used in stained glass, weights used in stock cars, dyes and glazes used in pottery and many other places.

If you have a job or hobby where you may come into contact with lead:

• Never put leaded materials (for example, fishing sinkers, lead came or solder for stained glass or leaded pottery clay or glaze) in your mouth.
• Use proper ventilation and equipment when melting lead to cast your own bullets, sinker, decoys or other metal items.
• Avoid handling food or touching your mouth or face while engaged in working with lead materials, and wash hands before eating or drinking following such activities.
• Shower and change clothes before entering your vehicle or coming home.
• Launder your work and hobby clothes separately from the rest of your family's clothes.
• Keep all work and hobby materials away from living areas.

Folk Remedies

Some folk remedies that contain lead, such as "greta" and “azarcon,”are used to treat an upset stomach. Some folk remedies for morning sickness, including "nzu", "poto" and "calabash chalk," contain dangerous levels of lead and other chemicals. Consuming even small amounts of lead can be harmful. Lead poisoning from folk remedies can cause serious and irreversible illness.

Many houses and apartments built before 1978 have lead-based paint. If you think your home has lead-based paint:

• Check your home
• Maintain your home’s condition
• Learn about lead-safe certified firms before you renovate
• Learn if you have lead in your drinking water

Check Your Home

If your home was built before 1978 and you suspect it contains lead-based paint, have your home tested for lead and learn about potential lead hazards. There are a few options available to test your home for lead-based paint:

• A lead-based paint inspection — Tells you if your home has lead-based paint and where it is located. It will not tell you whether your home currently has lead hazards or how to deal with it. This is most helpful when buying a home or signing a lease, before renovating.
• A lead-based paint risk assessment — Tells you if your home currently has any lead hazards from lead in paint, dust or soil and what actions to take to address these hazards. This is most helpful if your home is known or suspected to contain lead-based paint.
• A combination inspection and risk assessment – Tells you if your home has any lead-based paint and if your home has any lead hazards, and where both are located.

For either option, you should hire a certified lead professional to test your home for lead and to do any needed work. There are standards in place for certifying lead-based paint professionals to ensure the work is done safely, reliably and effectively.

• Locate a trained professional in your area who can evaluate and test your home for lead.
• Learn if you have lead in your drinking water.

Maintain Your Home’s Condition

It is very important to properly care for the lead-painted surfaces in your home. Lead-based paint in good condition is usually not harmful. If your home was built before 1978:

• Regularly check your home for chipping, peeling, or deteriorating paint. Fix small areas (under six square feet) of damaged paint as soon as possible without excessive sanding. If you must sand, sand the minimum area needed, wetting the area first, and clean up thoroughly.
• Regularly check all painted areas that rub together or get lots of wear, like windows, doors and stairways, for any signs of deterioration.
• Regularly check for paint chips or dust – if you see some, remove carefully with a damp paper towel and discard in the trash, then wipe the surface with a clean wet paper towel.
• Wipe down flat surfaces, like window sills, at least weekly with a damp cloth or paper towel.
• Mop smooth floors (using a damp mop) weekly to control dust.

Here are more tips to help you reduce or prevent your family’s exposure to lead dust. It’s best to follow these steps weekly.

Cleaning Uncarpeted Floors

Do:

• Damp mop with a standard sponge or string type mop and an all-purpose cleaner.

• Clean with a standard vacuum cleaner if no visible dust or debris from chipping or flaking paint is present.

Don’t:

• Mop with a scrubber strip attached.
• Power buff or use polishing machines or vacuums with beater bars that may wear away the painted surface.

Cleaning Carpets and Rugs

Do:

• Wet scrub or use steam cleaning methods to remove stains.
• Clean with a standard vacuum cleaner if no visible dust or debris from chipping or flaking paint is present. Use only vacuums with High Efficiency Particulate Air (HEPA) filters if visible dust or debris from chipping or flaking paint is present.

Don’t:

• Dry sweep the surface dust and debris.
• Shake or beat carpets and rugs.

Cleaning or Dusting Walls and other Painted Surfaces

Do:

• Clean with a soft, disposable cloth dampened with an all-purpose cleaner.

Don’t:

• Use steel wool, scouring pads and abrasive cleaners.
• Apply solvent cleaners that may dissolve paint.
• Excessively rub spots to remove them.

Learn About Lead-Safe Certified Renovation Firms Before You Renovate

Renovation, repair and painting jobs in pre-1978 homes and buildings can create significant amounts of lead-based paint dust. If your contractor will disturb lead-based paint while renovating, repairing or painting your home, he or she must be trained in lead-safe work practices.

• Find a lead-safe certified renovation firm in your area.
• Read EPA's fact sheet on using a lead-safe certified contractor (PDF) .
• If you are a do-it yourselfer, then learn how to protect yourself and your family from exposure to lead-based paint.
• If you are a renter, then learn the procedures put in place to protect your family.

Learn If You Have Lead in Your Drinking Water

EPA requires all community water systems to prepare and deliver an annual water quality report called a Consumer Confidence Report (CCR) for their customers by July 1 of each year. Contact your water utility to request a copy of its latest report. If your water comes from a household well or other private water supply, then check with your health department, or with any nearby water utilities that use ground water, for information on contaminants of concern in your area.

• Find your local Consumer Confidence Report.
• Learn more about protecting water quality from private drinking water wells.

The most common sources of lead in drinking water are lead pipes, faucets and fixtures. Lead pipes are more likely to be found in older cities and homes built before 1986. Since you cannot see, taste or smell lead dissolved in water, testing is the only sure way of telling whether there are harmful quantities of lead in your drinking water. A list of certified laboratories is available from your state or local drinking water authority. Testing typically costs between $20 and $100. Contact your water supplier as it may have useful information, including whether the service connector used in your home or area is made of lead.

Reduce Your Exposure to Lead in Drinking Water at Home

• Use cold water. Use only cold water for drinking, cooking and making baby formula. Boiling water does not remove lead from water.
• Clean your aerator. Regularly clean your faucet screen (also known as an aerator). Sediment, debris and lead particles can collect in your aerator. If lead particles are caught in the aerator, lead can get into your water.
• Use your filter properly. If you use a filter, make sure you use a filter certified to remove lead. Read the directions to learn how to properly install and use your cartridge and when to replace it. Using the cartridge after it has expired can make it less effective at removing lead. Do not run hot water through the filter.
• Run your water. Before drinking, flush your pipes by running your tap, taking a shower, or doing laundry or a load of dishes. The amount of time to run the water will depend on whether your home has a lead service line or not, and the length of the lead service line. Residents should contact their water utility for recommendations about flushing times in their community.
• Have your water tested. Contact your water utility to have your water tested and to learn more about the lead levels in your drinking water.

There is no safe blood lead level in children. Even low levels of lead in blood can hurt a child’s ability to learn, pay attention, and do well in school.

The good news is that childhood lead poisoning is preventable. Learn about common sources of lead and steps to reduce your child’s risk of lead exposure.

Know the common sources of lead

Lead can be found where children live, play, and learn.

• Paint. In homes or buildings built before 1978, assume that the paint contains lead unless tests show otherwise. When the paint peels and cracks, it makes lead paint chips and dust. Children can be exposed to lead if they eat flaking paint chips or breathe in lead dust.
• Soil. Lead particles from exterior lead-based paint, leaded gasoline, aviation fuel and lead industries can settle in soil and last for years. Children can be exposed to lead in soil by touching, breathing, or playing in lead-contaminated soil. This soil can also get on shoes and clothes and be brought into the home or other locations where children spend time.
• Water. Some water pipes, faucets, and plumbing fixtures may contain lead that can get into drinking water.
• Consumer products. Lead can be found in toys, jewelry, antiques, and collectible items. Some glazes used on ceramics, china, and porcelain also contain lead, which might get into food.
• Imported foods and medicines. Some candies, candy wrappers, spices, cosmetics, traditional medicines, and ceremonial or religious powders purchased or brought from outside the US contain lead.
• Jobs and hobbies. Certain jobs and hobbies, such as stained-glass work, involve lead-based products and might result in parents or caregivers bringing lead into the home.

Take steps to prevent lead exposure

There are many things you can do to protect your family from lead exposure.

Make your home lead-safe

• Check your home. If you live in a home built before 1978, have your home checked by a licensed lead inspector. If you rent, ask your landlord to have your home checked.
• Check your drinking water. Contact your water provider to find out if you have a lead service line connected to your home. If there is lead in your tap water, take steps to reduce or eliminate exposure. More information can be found at https://www.cdc.gov/nceh/lead/prevention/sources/water.htm.
• Renovate safely. Home repairs and renovations, such as sanding or scraping paint in homes built before 1978, can release lead dust. If you are planning renovations, use only approved methods for removing lead hazards from your home and use contractors certified by the Environmental Protection Agency.

Make sure your products do not contain lead

• Avoid certain children’s products and toys. Some toys, especially imported toys, antique toys, and toy jewelry may contain lead. You can find photos and descriptions of currently recalled toys at cpsc.gov/recalls
• Be safe in the kitchen. Some imported or antique ceramics and pottery dishes are glazed with lead. This glaze might contaminate food when stored or prepared in these dishes.
• Avoid certain traditional medicines and cosmetics. Avoid using traditional medicines (such as azarcon, greta, and pay-loo-ah) and cosmetics (such as kohl and sindoor) that contain lead. If you are not sure if a product contains lead, do not allow your child to use it.
• Use caution when eating certain foods. Avoid eating spices, candies, and other foods that were purchased abroad from informal or unregulated sources. Foods that were produced following proper licensing and regulations are more likely to be safe for children.

Take everyday steps to stay healthy

• Give your child healthy foods. A balanced diet with foods that provide calcium, iron, and vitamin C may help keep lead out of the body. Many of these foods can be bought with food vouchers from food assistance programs.
• Wash hands and toys. Make sure your child washes his or her hands and face after playing outside or with pets that might have lead particles from soil on their fur or paws. Regularly wash children’s toys, which might become contaminated from lead in soil or household dust.
• Remove all shoes when you enter the house. Take your shoes off when you enter the house to prevent spreading lead-contaminated dust through the home.
• Be safe when working with lead. If you or someone who lives with you works with lead, have them change into clean clothing before coming home. Keep their work or activity shoes and tools outside and wash their clothes separately from the rest of the family’s clothes.

Get your child tested for lead exposure

Talk to your healthcare provider about getting a blood lead test for your child. A blood test is the best and most readily available way to determine if a child has been exposed to lead. Based on blood lead test results, healthcare providers can recommend follow-up actions and care.

1. 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 effects 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 affect how different 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 effects 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.

2. Is there any safe level of lead for a child?

No safe blood lead level in children has been identified. Children are especially at risk from lead because of their small size and developing brains. Lead exposure can affect nearly every system in the body. Even low levels of lead in blood have been shown to negatively affect a child’s intelligence, ability to pay attention, and academic achievement. Removing all sources of lead exposure is important before a child is harmed. The good news is that childhood lead poisoning is preventable. The most important step that parents and caregivers, healthcare providers, and public health professionals can take is to prevent lead exposure before it occurs.

3. How do you find out if a child has been exposed to lead?

A blood lead test is the easiest way to find out if a child has been exposed to lead. Most children with lead in their blood have no obvious symptoms. If a child may have been exposed to lead, the child’s parent or caregiver should talk to their health care provider about getting a blood lead test.

Health care providers and most local health departments can test for blood lead. Many private insurance policies cover the cost of testing for blood lead. The cost of blood lead testing for children enrolled in Medicaid is covered by the Centers for Medicare & Medicaid services. Children enrolled in Medicaid should be tested at ages 12 and 24 months. Contact the appropriate childhood lead poisoning prevention program in your area for questions about testing for lead.

Pediatric Environmental Health Specialty Units (PEHSU) are also a source of information. PEHSUs are a regional source of medical information and advice on environmental conditions that influence reproductive and children’s health. They work with health care professionals, parents, schools and community groups, and others to provide information on protecting children and reproductive-age adults from environmental hazards.

4. What are the risk factors for childhood lead exposure?

Children under 6 years of age are at greatest risk for health problems caused by lead exposure. This is because their bodies are still developing and growing so rapidly. Young children also tend to put their hands or other objects, which may be contaminated with lead dust, into their mouth.

Any child can be exposed to lead. However, some groups of children are at higher risk, including children who:

• Live or spend time in homes built before 1978, especially those with paint that is chipping, peeling, or in poor condition.
• Live in pre-1978 housing with recent, ongoing, or planned renovation or remodeling.
• Are in households with incomes below the federal poverty level.
• Are members of racial-ethnic minority groups that have been economically/socially marginalized.
• Are recent immigrants from countries with lead in the environment.
• Have siblings, housemates, or playmates with known lead exposure.
• Have parents or household members who are exposed to lead at work or through a hobby.
• Live near active lead and other types of smelters, battery recycling plants, or other industries that release lead into the air.

Children who are exposed to lead through certain consumer products are also at a higher risk. These consumer products include:

• candy and candy wrappers, spices, and toys or jewelry
• traditional medicines and cosmetics
• herbal and Ayurvedic remedies
• lead-glazed antique or handmade pottery or cookware
• and leaded crystal glassware

5. What follow-up actions are recommended for children with lead in their blood?

A child’s health care provider is the best resource for addressing issues about their health. If a child has lead in their blood, a doctor may recommend actions such as finding and removing lead from your home, feeding the child a diet high in iron and calcium, connecting the child to early educational services, and follow-up blood lead testing. Early intervention is key to reducing long-term effects. If a child has high levels of lead in their blood, health care providers may recommend other types of testing and treatment to remove some of the lead from the blood. This may include getting an x-ray to determine if a child has high levels of lead in their blood. If a child has very high levels of lead in their blood, they may receive chelation therapy, which is a medical treatment used to remove lead from the body. For more information on caring for children with lead in their blood, refer to CDC’s Recommended Actions Based on Blood Lead Level.

State and local childhood lead poisoning prevention programs can provide information about treating childhood lead exposure. To find a childhood lead poisoning prevention program in your area, go to https://www.cdc.gov/nceh/lead/programs/default.htm.

Pediatric Environmental Health Specialty Units (PEHSU) are also a source of information. PEHSUs are a regional source of medical information and advice on environmental conditions that influence reproductive and children’s health. They work with health care professionals, parents, schools and community groups, and others to provide information on protecting children and reproductive-age adults from environmental hazards. Contact information for the PEHSU in your region can be found at https://www.pehsu.net/findhelp.html.

6. Can lead affect an unborn baby during pregnancy?

If a person is exposed to lead during their pregnancy, their developing baby can also be exposed.

Too much lead in your body while pregnant can:

• Put you at risk for miscarriage
• Cause your baby to be born too early or too small
• Hurt your baby’s brain, kidneys, and nervous system.
• Cause your child to have learning or behavior problems.

7. Is there a cure for lead poisoning?

There is no cure for lead poisoning. That is why preventing exposure to lead, especially among children, is important. Finding and removing sources of lead from the child’s environment is needed to prevent further exposure.

While there is no cure, parents can help reduce the harmful effects of lead exposure by talking to their doctor and getting connected to learning, nutritional, and behavioral programs as soon as possible.

8. What can parents and caregivers do to protect their family from lead exposure?

Parents and caregivers should find out the year their home was built. If a child spends a lot of time somewhere else, such as a grandparent’s home or daycare, parents and caregivers should also find out the year when that place was built. In homes or buildings built before 1978, assume that the paint contains lead unless tests show otherwise. There is also likely to be lead in the soil around older buildings, either from exterior paint or vehicle emissions.

Parents or caregivers can take the following additional steps to protect their family from lead exposure.

• Talking to their child’s health care provider about getting a blood lead test. A blood test is the easiest way to determine if a child has been exposed to lead.
• Getting their home checked for lead hazards including lead-based paint if it was built before 1978. Renters should ask their landlord to have their home checked for potential lead sources.
• Asking their local water authority to test their water for lead. If there is lead in their tap water, take steps can be taken to reduce or eliminate exposure.
• Using only approved methods for removing lead hazards or use EPA- or state- approved Lead-Safe certified renovation firms.
• Fixing surfaces in the home that have peeling or chipping lead-based paint. Renters should talk to their landlord about fixing this.
• Regularly cleaning floors, windowsills, and other surfaces using wet methods and take precautions to avoid lead dust when remodeling.
• Removing shoes or wiping soil off shoes before entering the house.
• Washing children’s hands, bottles, pacifiers, and toys often.
• Making sure children eat nutritious meals high in iron and calcium.

9. How can lead be safely removed from a home or building?

Lead-safe certified contractors can safely renovate houses and other buildings. The United States Environmental Protection Agency’s (EPA) Lead Renovation, Repair and Painting Program describes steps contractors can take to safely renovate homes built before 1978. A certified risk assessor can help decide whether abatement (eliminating lead hazards completely) is a better option.

10. How can someone find out if their household water contains lead?

You cannot see, taste, or smell lead in drinking water. The best way to know the risk of lead exposure through drinking water is to have a lead test conducted on the water. Many public water providers will test drinking water for residents upon request. Renters can ask their landlord to have their water tested for lead.

Many public water providers have data on drinking water quality, including lead levels, as part of their annual Consumer Confidence Reports. More information is available on the U.S. Environmental Protection Agency’s (EPA) website.

Property owners can ask their water provider if a lead service line provides water to their home. If they have a lead service line, they can ask if there are any programs to assist with removing lead service line going to their home. Understand that any work, such as water main or service line replacement, could increase exposure to lead while the work is ongoing and for up to six months after the work is completed.

At a glance

• MIS-C may begin weeks after a child is infected with SARS-CoV-2. The child may have been infected from an asymptomatic contact, and, in some cases, the child and their caregivers may not even know they had been infected.
• COVID-19 vaccination is effective at reducing the risk of MIS-C.

Signs and symptoms

• Patients with MIS-C usually present with fever and some combination of abdominal pain, vomiting, diarrhea, skin rash, and mucocutaneous lesions (i.e., conjunctivitis). In severe cases, children can present with hypotension and shock.
• Patients with MIS-C have elevated laboratory markers of inflammation (e.g., C-reactive protein, ferritin); many have laboratory markers indicating damage to the heart (e.g., elevated troponin), and many have low platelet or absolute lymphocyte counts (thrombocytopenia and lymphopenia, respectively).
• Some patients develop cardiac dysfunction (e.g., decreased left ventricular function) and coronary artery dilatation or aneurysm.
• Gastrointestinal inflammation can manifest as abdominal pain, vomiting, and diarrhea; children may have signs and symptoms similar to those of acute appendicitis.
• Neck pain has also been described, sometimes with development of phlegmon on radiographic imaging.
• Children with MIS-C can also have neurologic involvement which is usually transient and presents as headache or altered mental status.
• Other severe neurologic manifestations may include encephalopathy, stroke, demyelination, and fulminant cerebral edema, although this is rare.
• Not all children will have the same signs and symptoms, and some children may have symptoms not listed here. MIS-C may begin weeks after a child is infected with SARS-CoV-2. The child may have been infected from an asymptomatic contact, and, in some cases, the child and their caregivers may not even know they had been infected.

Reducing risk

MIS-C and vaccination

• Multiple studies have found that COVID-19 vaccination is effective at reducing the risk of MIS-C, with one CDC study finding that two doses of Pfizer-BioNTech COVID-19 vaccine had a greater than 90% estimated effectiveness at preventing MIS-C.