Commissioner's Letter to Health Care Providers Regarding Low Level Lead Exposure, June 2009

June 2009

Dear Doctor/Health Care Provider:

The purpose of this letter is to share new materials on childhood lead poisoning with you, developed by the New York State Department of Health (NYSDOH). A growing number of epidemiological studies show that blood lead levels (BLLs) between 5 and 10 µg/dL in young children are associated with learning disabilities, behavior problems, and lowered intelligence. Such low-level exposure to lead harms thousands of children each year, whose BLLs do not fit the current definition of lead poisoning. Some of your young patients are undoubtedly affected: New York has more pre-1950 housing containing lead paint than any other state in the nation, found in approximately 43 percent of all of New York's dwellings.

In response to our greater understanding of lead's effects on pediatric health, the NYSDOH has developed new educational materials for use in your office that will help parents understand their children's blood lead test results. A copy of these educational materials is enclosed. In addition, all laboratory blood lead test reports in New York State (NYS) will now include the following comment language: "Blood lead levels in the range of 5-9 µg/dL have been associated with adverse health effects in children aged 6 years and younger." The term "normal" should no longer be used to describe BLLs less than 10 µg/dL.

Both the federal Centers for Disease Control and Prevention (CDC) and the NYSDOH urge medical providers to do more to identify and proactively address children's BLLs. In 2007, the CDC issued new recommendations for the interpretation and management of BLLs less than 10 µg/dL in children. 1 Consistent with NYS regulations, the CDC stresses that all parents of young children should receive anticipatory guidance on lead poisoning prevention. The CDC also recommends that providers consider more frequent testing (i.e. more than annually) for children whose BLLs are approaching 10 µg/dL, particularly children under two years old, or at high risk for lead exposure.

NYS Public Health Law and regulations require medical providers to test all children for lead with blood lead tests at age one year and again at age two years. A recent analysis of NYS blood lead test data showed that 8.5 percent of children who had BLLs of 5 to 9 µg/dL at age one had BLLs of 10 µg/dL or higher when tested again at age two, underscoring the importance of the second screening test at age two. Providers are also required to assess lead risk at each well-child visit for all children ages six months to six years, and if risk is found, perform blood lead tests, or refer for testing, and to provide anticipatory guidance for all families about lead poisoning prevention as part of routine care.

Thank you for your efforts to eliminate childhood lead poisoning in NYS. The new educational materials can be photocopied, printed from the NYSDOH Web site, or ordered with the enclosed order form. Also enclosed is contact information for county health departments and regional lead resource centers. If you have any questions or would like additional information, please contact your local health department, or the NYSDOH Lead Poisoning Prevention Program at 518-402-5706, or visit:


Richard F. Daines, M.D.
Commissioner of Health

1Centers for Disease Control and Prevention. Interpreting and Managing Blood Lead Levels < 10 mcg/dL in Children and Reducing Childhood Exposures to Lead: Recommendations of CDC's Advisory Committee on Childhood Lead Poisoning Prevention. MMWR 2007;56(No. RR-#8): [1-16]. Posted on: