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When should babies be tested for Lead? How often should babies be tested for Lead?

2024 Article

For those new to the Lead Safe Mama 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 four sons were acutely Lead-poisoned in 2005).

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Advertising and affiliate income help Lead Safe Mama, LLC cover the costs of the work we do here (independent consumer goods testing and childhood Lead-poisoning prevention advocacy). We have removed ads from most of our more widely-read articles (including this one!) to make them easier for you to read. In addition to supporting this work by starting any shopping you might be doing with a click on our affiliate links (for Lead-free products), if you would like to support the independent consumer goods testing and childhood Lead-poisoning prevention advocacy work of Lead Safe Mama, LLC by making a contribution (which will also help us keep our more widely-read articles ad-free), click here. Thank you!

Published: Monday, June 3, 2024

Questions Frequently Asked on Lead Safe Mama, LLC’s Social Media Pages:

  • When should my baby be tested for Lead?
  • How old should my baby be when they are first tested for Lead?
  • Why has my doctor not recommended a Lead test for my baby yet?
  • How often should my baby be tested for Lead?
  • How often should my older child be tested for Lead?
  • I’m pregnant, should I get tested for Lead?
  • I’m trying to get pregnant, should I get tested for Lead?

While Lead testing is supposed to be “universal” (for all babies of a certain age) in some cities or states, this is not the case, in practice… In communities with requirements that doctors offer “universal” Lead-testing to parents by the time children are 12-months-old, and 24-months-old, typically no more than 50% of children are actually tested at their one-year and two-year checkups in these communities.

Outside of these communities (which are few and far between), Blood Lead Level testing for children is far less common.

In addition to the lack of testing completed, using the ages of 12 and 24-months (the CDC’s current recommendation for children on Medicaid — see screenshot below) is rather arbitrary – and not a beneficial schedule for actually protecting children via primary prevention (preventing Lead-poisoning BEFORE it happens). The 12-month/ 24-month schedule for Blood Lead Level testing has only been set as a matter of convenience — as it coincides with the vaccine schedule and regular periodic checkups that most parents take their infants to.

Based on our nearly two decades of experience helping families with Lead-poisoned children, below is what we (Lead Safe Mama, LLC) recommend for a Blood Lead Level (BLL) testing schedule — starting with preconception and going all the way through the teen years: 

#1.) Preconception Test for Biological Mom & Biological Dad

  • Before a baby comes into the picture, future Moms need to be tested (screened)!
  • Future mothers should be tested for Lead annually (along with the schedule for their Pap smear/ OBGYN checkups). In this way, if Lead is found, the future mother can become aware of the concern, have time to address Lead hazards in the home, and adjust her own health risks (or in-utero risks to a future baby) before conceiving.
  • This is a common-sense public health screening practice the Lead Safe Mama advocacy community has been advocating for over nearly two decades now — but that is still not yet something OBGYN’s have in their tool-kit. If more potential/ future mothers demand this pre-conception testing, we may actually create a change (demand-based-change) within the medical protocols.
  • The screening test (in-office finger-prick test) has a per-test cost of about $8. The machine that runs this testing in the office costs about $3,000. It is not an expensive protocol for doctors’ offices to integrate into their work, and would be a great “value added” resource to attract new patients!
  • Given the solidly studied and well-established links between maternal Lead-exposure and infertility and birth complications (you can read more about that here), getting a Blood Lead test once you decide you want to get pregnant is an important first step (especially if there is a family — or community — history of infertility, or conception issues).

#2.) Prenatal Test for Biological Mom

  • The minute an expectant mom finds out she is pregnant, she should get a Blood Lead test. This is the simplest way to protect the future baby from potential Lead exposure in their home.
  • If an expectant mother tests positive for a Blood Lead Level (BLL) greater than 0.4 micrograms of Lead per deciliter of blood, she likely has a source of Lead exposure in her home, her life, or her diet.  (You can read more about diet concerns here.)

#3.) Baby’s First Test

  • Children should first get tested BEFORE they start crawling.
  • Ideally, the moment you suspect they might be about to crawl, ask your doctor for a BLL test at their next visit (if it is coming up in the next week or two) or schedule a BLL test for your baby before your next visit (if your next visit is more than two weeks away).
  • Babies crawl at different ages.
    • One of my babies was very tall and heavy — he didn’t really start crawling until he was almost a year old. (He’s now a 6’2″ tall grown man!)
    • Another of my babies was super-tiny at birth (5 lbs 10 oz) and he started crawling very early — closer to 6-months-old. (He’s now a 5’10”-tall grown man!)
    • You (the parent) are the person who is most likely to predict if your baby is about to crawl, so you are the best person to gauge when this test should be.
  • Generally, we recommend that testing in the “pre-crawling” phase offers a useful baseline. Babies should be first tested for Lead when they are between 6 and 8-months-old, depending on where they are personally. This is much earlier than what most doctors will conduct testing, and much earlier than what most doctors recommend (although we have heard that doctors around the United States are actually now finally beginning to come on-board with this testing schedule, and are communicating it to their patients!).
  • It is best to take babies to a pediatric phlebotomist at your local children’s hospital, if at all possible. Pediatric phlebotomists are incredibly skilled at testing even the tiniest babies and usually are able to do so without the baby experiencing any sort of trauma.
  • By testing a baby for Lead exposure before they start to crawl, you accomplish several things:
    1. You document a baseline for your baby. You know what your baby’s Blood Lead Level (BLL) is BEFORE they have likely had any measurable exposure from direct contact with any painted surfaces, (possibly-contaminated) house dust, or other location-specific possible exposure sources. Having a baseline will serve you in the future, in the event that your baby is ever poisoned (both from a legal perspective in a case where you might need to demonstrate that your baby was not poisoned before a certain date, and from a health perspective to identify the time-frame during which your child was exposed, allowing you to better help identify and remove the source of exposure).
    2. If your baby tests “negative” for Lead (ideally below 0.5 micrograms of Lead per deciliter of blood, depending on the testing limits of the lab you use for testing — the low threshold of detection), then you know there are no likely sources of Lead exposure in the baby’s food source (including formula, breast milk, or baby food). You also know there are no likely sources of Lead exposure in the baby’s environment that are an inhalation-based hazard in the home (that a baby may have encountered in the home solely as a result of Lead in the dust circulating in the home).
    3. If your baby tests POSITIVE for Lead (at any level above a 0.5), you have caught the exposure early and have the opportunity to address the concern before it may likely cause lifelong damage to your baby (especially if you are able to identify and remove the source of exposure at this time). Please skip to section #4 for more info on what to do in this case!

Note: Before a baby starts crawling — and ideally, before a baby is born/ brought into the home — parents who live in either in a home built before 1978, or in an urban area (regardless of the age of the home) should complete some dustwipe sampling of the dust on the floors of their home to ensure their baby is not exposed to Lead when they begin crawling. You can take dust wipe samples yourself for as little as $75, OR you can hire a professional to test your home (which can potentially cost several hundred to several thousand dollars, depending on the the size of your home and the scope of the testing). Here’s an article detailing how to do it yourself (along with a link to the product for testing the dust in your home yourself by collecting samples and sending them off to a lab).

#4.) Baby’s Second Test

Following up on baby’s first test, baby’s second test should be immediately after they start crawling, if at all possible. This should be within two or three weeks of when they start crawling and no later.

  • If you have Lead dust in your home (that was not identified before you moved in, or not identified before the baby was born — as discussed in the closing note in section #3 above), your baby may test positive as soon as they start to crawl.
  • Blood Lead Levels in babies exposed to Lead dust on floors will spike (quickly elevate) virtually immediately. You don’t need to wait for longer-term exposure for the Lead to show up in a blood test — it will even show up the same day in the case of a significant incidental exposure.
  • Note: There is a myth in the medical community that it may take days, weeks, or months for a child’s blood Lead level to become elevated after an exposure. This is simply untrue/ not based in science.
  • By testing your baby as soon as they start to crawl, you significantly limit their potential Lead exposure (if it turns out they test positive) and you then have the opportunity to remove that child from the source of exposure. 
  • If you did a pre-crawling baseline test (and the results of that test were negative) then you can be fairly certain that the results of this second test are positive due to contaminated dust on the floor, since this is normally the primary change in the child’s activity between these two tests.
  • For this test, you also want to make sure the lab or doctor’s test uses testing methods that evaluates Blood Lead Levels down to at least single digit decimal places (with a low threshold of detection at 0.5 micrograms of Lead per deciliter of blood or lower). Getting a test result of “less than 3” or “less than 2” is not very helpful but may be the only testing result that some clinics have access to. You can read more about that here.

#5.) Baby’s Third (and subsequent) Test(s)

Depending on your baby’s age at the time of the second test, and depending on the outcome of the first test, timing for your baby’s third test will vary.

Did your baby test positive at their last test?

  • If your baby tests positive at their first or second test (especially if they are positive with a BLL of 1.0 or higher), it is important to do your best to immediately identify the source of exposure and remove the child from the source of exposure. 
  • Typically, exposure sources for BLL’s under 3.0 are food-based/ diet-based exposure sources (you can read more about that here).
  • Typical exposure sources for BLL’s of 3.0 and higher (and especially for 4.0 and higher) are house-related (or consumer goods interaction-related) — with the most common exposure source for levels that high being Lead-contaminated house dust. 
  • At this point, if your baby has tested positive for Lead and you have not yet watched our documentary film on the subject, we highly encourage you to do so as it will help you understand the potential exposure sources (help you identify them, and help you remove your child from those exposure sources). Here’s the link to the film.
  • If your baby tested positive with a BLL of 1.0 or higher, you should have them tested again in one or two months (possibly three months, depending on the suspected source of exposure).
  • If your baby tested positive with a BLL of 3.0 or greater, you should consider moving out of your home immediately (upon learning of those test results), working to identify the suspected source of exposure, and re-testing them 30 to 45 days after removing them from the suspected source of exposure (with the “half-life” of Lead-in-blood being 30 to 45 days, their BLL should be 50% of their previous test at that time if you have literally removed them from the source).
  • If you cannot remove the child from the home after a positive BLL test of 3.0 or higher, they should be tested monthly until the exposure source can be addressed — this will ensure their level does not spike while you are working to address the hazards in your home/ identify exposure sources.

Did your baby test negative (below a BLL of 0.5) at their last test?

  • Great! This is wonderful news. 
  • If you live in a home built before 1978, your children should continue to be tested at least every six months.
  • For children under the age of 2 living in a pre-1978 home, it would not be unreasonable to test them quarterly (after the first two tests) in this case.
    • Test #1) before crawling (6-8 months)
    • Test #2) after crawling (8-12 months)
    • Tests after that:
      • 15 months
      • 18 months
      • 21 months
      • 2-years-old
    • If your first several tests continue to be negative (less than 0.5), you may wish to do the later tests at longer intervals.
    • In the case of an exposure, the sooner you can identify the exposure source(s), the more quickly it/ they can be taken care of, and the child can be protected.
    • Unfortunately, for many families who lack the resources to thoroughly test their home (and/or remediate any confirmed Lead hazards in their home), just continuing to get regular blood Lead tests for their children to at least monitor exposure, and personally do whatever they can to eliminate or reduce exposure themselves is all they can manage financially…
  • For children living in a post-1978 home, but in an urban environment, testing every 6 months (after the first two tests) is not unreasonable.
  • For children living in a post-1978 home and not living in an urban environment, following a BLL test with a negative (or “less than 0.5”) test result after the second test and testing annually through at least the teen years (through age 18) is a good idea.

This list of considerations is not exhaustive as there are exceptions to many scenarios, but these are general guidelines based on our experience working with families of Lead-poisoned children over the past 18 years.

#6.) “Wait, what? Testing annually through age 18? That sounds ‘excessive!'”

Dr. John Rosen is quoted in my documentary film stating that children should be tested annually through the teen years. The (logical) reasoning for this is as follows:

  • Kids of any age can be Lead-poisoned. Lead poisoning is in no way limited to children under 6-years-old.
  • We have worked with many children who have been poisoned from household sources (or school-based sources) as older children (even through the teen years and beyond).
  • Teenagers (and “tweens”) also engage in activities that might cause them to be poisoned — activities not typically engaged in by younger children. Some examples include:
    • Auto-shop classes
    • Stained glass making
    • Shooting sports 
    • Hunting
    • Fishing
    • Soap Box Derby (a Boy Scouts/ related group activity)
    • Electronics building (anything with solder, as even most “Lead-free” solder actually contains unsafe levels of Lead and can create Lead-contaminated fumes that can be inhaled!)
    • Making toy soldiers (or D&D figurines) or other miniatures out of Lead or Lead-alloys
    • Painting (as a summer job, perhaps, repainting sheds, garages, porches, or homes?)
  • Given all of these potential sources for older children, testing annually is a reasonable practice.
  • If an older child is specifically engaged in one or more of the above activities on a regular basis (not just as a one-time thing), they should both look for confirmed Lead-free alternatives for the materials used, AND get tested more frequently to make sure they are not exposing themselves and are working safely.

Some additional relevant reading (& videos) that may be of interest:

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