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For those new to this website:

Tamara Rubin is a multiple-federal-award-winning independent advocate for childhood Lead poisoning prevention and consumer goods safety, and a documentary filmmaker. She is also a mother of Lead-poisoned children (two of her sons were acutely Lead-poisoned in 2005). Since 2009, Tamara has been using XRF technology (a scientific method used by the U.S. Consumer Product Safety Commission) to test consumer goods for toxicants (specifically heavy metals — including Lead, Cadmium, Mercury, Antimony, and Arsenic). All test results reported on this website are science-based, accurate, and replicable. Items are tested multiple times to confirm the test results for each component tested. Tamara’s work was featured in Consumer Reports Magazine in February of 2023 (March 2023 print edition).

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The Nurse told me my child’s blood Lead level was “<2.” Is my child poisoned?
What should I do now?

Hi there! You probably have a very young kiddo who just got their first blood Lead level test (BLL test), and so you are new to this conversation. This means you should read this piece in full, but I want to start with what I always tell parents who are new here: Don’t worry! There’s never any benefit to worrying; just take steps moving forward to do a bit of research and educate yourself (stick to the legitimate science — avoiding the pervasive, persistent folklore, anecdotes, and “woo” surrounding the issue of Lead-poisoning, whether fear-inducing, exaggerated, hysterical, comforting, dismissive, or palliative!).

A BLL of “<2” is NOT a “positive test result.”
Your child has NOT tested “positive” for Lead; 
A BLL of “<2” is also NOT a “negative test result.”
With this test result, they have NOT tested “negative” either.

• A “less than 2.0” reading IS a GREAT place to start, but there is still more research for you to do on the subject — because a “less than 2.0” reading could mean your child has NO Lead in their blood OR it could mean that they might come in at a BLL as high as (for example) 1.9 if a more sensitive/ accurate testing methodology were to be used by your doctor’s office. You need more/ better data to make that determination.
• A “less than” reading is exactly that, an inconclusive (insufficiently specific) test report.
• If you get this type of test result from your doctor’s office, your child’s blood Lead level is “less than” the number given (normally in the measurement unit of “micrograms of Lead per deciliter of blood”) — if it has a “<” symbol in front of it.
• If you got a Blood Lead Level (BLL) test result of “less than 2” (which is how you read “<2”), that means your child’s test result is an “effective negative” within the limitations of the testing methodology used.
• It’s not a “true negative” but it is the best outcome/ the lowest possible reading for the testing methodology used by YOUR doctor’s office (or testing lab).
• If my child received a result of “less than 2.0” on a blood Lead level test I would likely look for a more accurate testing facility and have them re-tested in 3 or 4 months (6 months on the outside).
• NOTE: If your child’s result is “<1” (less than 1 microgram of Lead per deciliter of blood), that may often be the best possible (most accurate) test offered in your area, and it would be reasonable to not have your child retested again for 6 or 8 months (depending on their age and potential sources of exposure).
• In my documentary film (MisLEAD: America’s Secret Epidemic), Dr. John Rosen recommends that children/ young adults should be tested at least annually through the teen years (through 19 years old).

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Better understanding the “Less Than” readings for blood Lead testing:

If you get a “less than” result (and especially if the numerical value of your test result in this case is anything greater than a “1“), you may opt to look for a second, more accurate follow-up test. 

Possible “less than” readings generally look like one of the options below.

• • “< 1” [µg/dL] — read as “less than one microgram of Lead per deciliter of blood”
  • “< 2” — read as “less than two micrograms per deciliter”
  • “< 3” — read as “less than three micrograms per deciliter”
  • “< 3.3” — read as “less than three-point-three micrograms per deciliter”
  • “< 5” — read as “less than five micrograms per deciliter”

Why 3.3? That seems arbitrary!

Unfortunately, the most common “less than” reading is “less than 3.3.” — a threshold too high to be considered useful as anything more than a preliminary screening reading. The reason this is so common is that there is a testing device many doctors have in their offices that has a low threshold of detection of 3.3 µg/dL.

If you get a “less than” reading (with any number next to it) it does not mean that your child’s blood Lead level is that number. It means their result is some unspecified number that is less than that number.

As an example: If your child gets a “less than 3.3” (“>3.3”) their BLL could still be a 2.0 or a 3.0, which suggests likely ongoing/ current exposure (and is not definitely “negative”).

Many parents are happy to receive a “less than” reading — but I do encourage further research to develop a better understanding for anyone who gets a test result with a “less than” reading.

• To reiterate: Tests with results that are expressed as a “less than” reading should be considered a useful screening tool as they help to rule out higher levels of Lead exposure (which is definitely a good thing!).
• If you have the opportunity to get a finger-prick test at (for example) a free clinic, I wouldn’t pass it up. Finger-prick tests are quick (usually just taking about 3 minutes to get a reading back), and will normally give you a low threshold Blood Lead Level of “less than 3.3” (due to the restrictions of the most common blood analyzers used — instruments which were developed specifically for use as an in-the-field “screening” instrument).
• If you do get a “less than” result (with any of the above numbers), depending on the numeric value of your “less than” range, you may then choose to ask your doctor for a follow-up venous draw test to confirm the actual specific level.

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How to avoid getting a “Less Than” reading for future blood Lead tests:

1. Request the most accurate testing methodology available (normally a venous draw with the blood sample sent away to a lab).
2. Find out the low threshold of detection for the lab being used to analyze your sample.
   • This will likely require a call to either your doctor’s office or the lab itself.
3. Find out the margin of error for blood Lead tests done by the lab analyzing your sample.
   • This will also likely require a call to either your doctor’s office or the lab.
4. Ask for your actual BLOOD LEAD LEVEL. This is a real NUMBER (whole or decimal). Ask for it in the form of a written report.
5. Know your child’s BLL number (remember your number, and keep the paperwork on file for future reference).
6. Learn and understand the federal standards for blood Lead testing and how they relate to your number. The current United States “reference Level” (updated in 2021) is 3.5 micrograms of Lead per deciliter of blood. 
7. Get your child tested as early as possible.

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More on each of the above-numbered points below:

#1.) Ask (in advance of your testing appointment) for the most accurate testing methodology: A venous draw.

• If at all possible, the best test (with potentially the most accurate results) will normally come from a venous draw at a lab, however, not all labs are equal (and there are some exceptions to this).
• Finger-stick or toe-prick tests can be falsely high if the child’s toe or finger is contaminated with Lead dust from their environment. If you get a high finger-stick test result, they will want to re-do it with a venous test anyway, so if you skip straight to the venous you save time (and potential trauma of repeated jabs to your child).
• Call your doctor’s office in advance of your child’s BLL test and ask if they perform a venous draw (from the arm) or if they normally do a finger-prick or toe-prick.
• If they tell you they only have the capability of doing a toe or finger-prick in the office, call around to other labs, clinics, and hospitals in your area to find out who can do a venous draw and see if you can get your doctor to send a referral over to the organization that will conduct a venous draw. This is often at the local children’s hospital.

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#2) Call in advance of your testing appointment and find out the “low threshold of detection” for BLL tests at the lab where your child’s blood sample will be analyzed.

Common low thresholds of detection are:

• • 3.3 µg/dL
  • 2.µg/dL
  • 5 µg/dL
  • 1 µg/dL

In each of the above cases, the lowest possible reading for a test will be “less than” the number above (as discussed above). You want the lowest possible threshold of detection. A low threshold of detection of a Blood Lead Level 5.0 µg/dL is very high — and some of the more accurate labs have a low threshold of detection as low as 0.1 (and sometimes even lower)… so that’s your goal, if at all possible: As close to 1.0 or below 1.0.

My two youngest children’s last blood Lead tests came up as a BLL 0.4 and a BLL 0.8. Results to this degree of accuracy are possible, and preferable if you have access to a lab that has this capability.

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#3) Ask in advance of your testing appointment for the margin of error of the testing at the lab where your sample will be analyzed.

The margin of error is normally expressed either as a percentage or as a specific number of Blood Lead Level (BLL) points. So some (the best) labs will have a very small margin of error of 10%. Some examples:

• With a margin of error of 10%, if your child tests positive with a BLL of 1.0, then you know that the result is within the range of 0.9 to 1.1.
• If they test positive with a margin of error of 10%, and the result is a BLL 10.0, then you know their number is in the range of 9.0 to 11.0

A less useful margin of error (but still possible and common) is a margin of error of 2, or 3, — even 5 — blood Lead level points. In that case (as an example), if your margin of error is 3 points, it could look like this:

• Your child got a BLL of 4.0, so their actual range is anywhere from 1.0 to 7.0.
• Your child got a BLL of 10.0 — so the actual range is anywhere from 7.0 to 13.0.

A high margin of error can be particularly confusing if you are trying to track the change in your child’s Blood Lead Level over time. You might get a BLL 10 one time, and two months later get a BLL 8 — and if the margin of error is 3.0, those two numbers could represent essentially the same level of continuous exposure for that child (with no actual change). 

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#4) If you aren’t provided a specific number, ask for the exact number.

• When your child gets a blood Lead test result ask to see the PRINTOUT of the paperwork with their test result (if they call you with the result, ask if they can email you or mail you a printout with the test result).
• Note: Nurses OFTEN (way too often, unfortunately) misinterpret Blood Lead Level (BLL) tests. They often tell parents their child’s test result is a whole number when it is, in fact, a “less than” reading. So if the report says the result is “less than 2,” nurses in a rush might tell you your child’s result is a 2.0. This is why you need to see the test result paperwork yourself, to ensure you know if it is a real number or a “less than” result that you are being given.
• Make sure you have the EXACT number. Is it a BLL 10? or a BLL 10.5? Not all test results will have decimals (most are given in whole numbers).
• A test with no numerical value (and to some degree, a test with a value that is only “less than __” — such as “less than 3” or “less than 5”) is not particularly helpful.**
• If you are not given a number, you may want to re-read the points in this article and consider having the test redone with a more accurate testing methodology, at a lab that has a lower threshold of detection and a smaller margin of error.

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#5) Know your number!

• Knowing the exact number helps you to make informed decisions for your child.
• Knowing the exact number also gives you a baseline that you can compare future tests to — so you know if the child’s level goes up or down. 
• By knowing if your child’s Blood Lead Level changes (with periodic testing, every 6 months or so in infancy and toddlerhood, and then at least annually through the teen years), you can pinpoint a time frame of any exposure and therefore help identify the source of their exposure.
• This is especially useful if — in the future — they test positive at a higher level.

#6) Understand the federal standards (and history of the issue — link here), so you can clearly explain to your child’s doctor why they are misinformed (in the event they tell you that your child’s BLL is “NORMAL”).

• If a doctor has been practicing for a very long time (more than 10 or 20 years), they might be working with outdated standards for what they consider a concerning level of Lead in the blood (i.e. misinformed).
• Specifically, they may not be aware of the current science, which has established that there is no “safe” level of Lead in blood. 
• Your doctor may believe (again, based on an outdated standard) that as long as your child has a Blood Lead Level below some outdated reference number, (like 10.0!), they are “fine.”
• This is simply not true — and the doctor needs to do some current research if that is their perspective.
• If your child tests positive for any Lead in their blood and your doctor says your child’s level is “Normal” — please encourage them to watch my film (which includes interviews with many of the top doctors and researchers involved with the issue of Childhood Lead poisoning): https://youtu.be/eRKlaC2EjL0.
• If your child tests positive at a low level (under 5.0) and the doctor says their level is “Normal,” you may also want to share this article with them: LINK.
• The reference level has just (in late 2021) been lowered to 3.5, so your doctor SHOULD express concern if your child has a BLL of 3.5 or higher, but even levels as low as 2.0 and lower have been demonstrated (by repeated scientific studies) to cause long-term harm in humans.
• You may also want to share this article with them (about the impact of low levels of exposure on reproduction/ conception/ pregnancy/ birth.).
• And this article with recent research from Harvard (about pre-industrial levels of Lead in humans).

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#7) Get a baseline Blood Lead Level test as early as possible

Even if you have no concern for exposure, I encourage all parents to get a baseline blood Lead test for their children. I wish my children each had a baseline from an earlier test to compare to their test results at the time they were poisoned (that would have helped us assign liability to the contractor among other potential benefits!); however, in the 9 years of my experience as a parent before my children’s poisoning, it was NEVER ONCE suggested by their doctors that they be tested for Lead. Every child should be routinely screened, as Lead does not discriminate — it continues to seriously impact the lives of children (and their families) in all communities, irrespective of race, color, socioeconomic status, geography, level of education, etc. To see what a proper Blood Lead Level test result looks like, click here.

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Q. When should a child first get tested?
A. Earlier than doctors are currently recommending!

I always recommend that a child first get tested at 6 or 7 months (before they start to crawl), and then again 4 to 6 months after that first test (or as soon after they begin to crawl and as you are comfortable testing them). This way, you can find out a base level for the child at a time when they should not have had any environmental exposure (pre-crawling) and catch any post-crawling exposure before it is prolonged (and potentially more damaging).

Of course, to PREVENT exposure in the first place, it is best to test the house and floors first (using dust-wipe sample testing prior to a child inhabiting a home if possible, and definitely before crawling), so you can know the potential risk to the child. I understand that is not always possible, and still encourage the Blood Lead testing scenario above, regardless of whether or not the house has been tested (as exposure can come from grandma’s house, daycare, and/or other potential sources, too!). My friends at CertifiedKit.com offer a DIY dust-wipe testing kit or you can have a home inspector come do it for you.

As always, please let me know if you have any questions.

The article above is a subset of the information in this piece, linked here (in case you want more of the history and background of this concern). As always, please let me know if you have any questions.

Sincerely,

Tamara Rubin
#LeadSafeMama

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