ATSDR TOXZINE

LEAD 
2 
TABLE OF 

CONTENTS 

5............................ What is Lead? 


6............... Lead and the Environment 


8.........................Exposure to Lead 


11....................... Lead and the Body 


13................ Health Effects of Exposure 


15........................Lead and Children 


17................Reducing Risk of Exposure 


21......................... Exposure Testing 


22............... Governmental Regulations 


and Recommendations 

25................... Additional Information 

3 
4 
WHAT IS 

LEAD? 

Lead is a heavy, low melting, bluish-gray metal that occurs 

naturally in the Earth’s crust. However, it is rarely found 

naturally as a metal. It is usually found combined with two or 

more other elements to form lead compounds. 

Metallic lead resists corrosion (in other words, it is not easily affected by air or 

water). When exposed to air or water, thin films of lead compounds form and 

protect the metal. Lead is easily molded and shaped, and it can be combined with 

other metals to form alloys. Lead and lead alloys are commonly found in pipes, 

storage batteries, weights, shot and ammunition, cable covers, and sheets used to 

shield us from radiation. Storage batteries in cars and other vehicles use the largest 

amounts of lead. 

Lead compounds are used as pigments in paints, dyes, and ceramic glazes and in 

caulk. In recent years, the amount of lead used in these products has been reduced 

to minimize lead’s harmful effects on people and animals. Lead was once added to 

gasoline to increase octane rating, but it was phased out in the 1980s, and banned 

in gasoline for motor vehicles beginning January 1, 1996. Lead still can be used in 

gasoline for off-road vehicles and airplanes. It also is still used in some developing 

countries. Lead used in ammunition, which is the largest non-battery use, has 

remained fairly constant. However, even in bullets and shot and in fishing sinkers, 

lead is being reduced because of its harm to the environment. 

Most lead used by industry comes from mined ores (“primary”) or from recycled scrap 

metal or batteries (“secondary”). In the United States, lead is mined mainly in Alaska 

and Missouri. However, most lead today is “secondary” lead obtained from lead-acid 

batteries. Ninety-seven percent of these batteries reportedly are recycled. ◆

5 
LEAD AND THE 


ENVIRONMENT 


Lead occurs naturally in the environment. However, most of 

the high levels found in the environment come from human 

activities. 

Lead use increased the most during 1950–2000 and reflected increasing worldwide 

use of leaded gasoline. Lead can enter the environment through releases from 

mining lead and other metals and from factories that make or use lead, lead alloys, 

or lead compounds. Lead is released into the air when coal, oil, or waste is burned. 

Before leaded gasoline was banned, most lead released into the 

U.S. environment came from vehicle exhaust. In 1979 in the United 

States, cars released 208.1 million pounds (94.6 million kilograms) 

of lead into the air. In 1989, when lead was limited but not banned, 

cars released only 4.8 million pounds (2.2 million kilograms). Since 

the U.S. Environmental Protection Agency (EPA) banned leaded 

gasoline for highway transportation in 1996, the amount of lead 

released into the air has decreased further. Before the 1950s, 

another way lead got into the environment was through pesticides 

applied to fruit orchards. Once lead gets into the atmosphere, it 

can travel long distances if the lead particles are very small. Lead is 

removed from the air by rain and by particles falling to land or into 

surface water. 

Sources of lead in dust and soil include lead that falls to the ground 

from the air and from weathering and chipping of paint that contains lead (leadbased paint) from buildings, bridges, and other structures. Landfills can contain 

waste from lead ore mining; ammunition manufacturing; and other industrial 

activities, such as battery production. Disposal of lead-containing products 

contributes to lead in municipal landfills. Past uses of lead—such as in gasoline—are 

a major contributor to lead in soil, and higher levels of lead in soil are found near 

roadways. Most lead in inner city soils comes from old houses with lead-based paint 

and previous automotive exhaust emitted when gasoline contained lead. 

Once lead falls onto soil, it sticks strongly to soil particles and stays in the upper layer 

of soil. That is why past uses of lead, such as in gasoline, house paint, and pesticides, 

are so important in the amount of lead found in soil. 

6 
Environmental 

levels of lead 

have increased 

more than 

1,000-fold 

during the past 

three centuries 

as a result of 

human activity. 

Small amounts of lead can enter rivers, lakes, and 

streams when rainwater moves soil particles. Small 

amounts of lead from lead pipe or solder can be released 

into water when the water is acidic (or “soft”). Lead can 

stick to soil particles or sediment in water for many years. 

Movement of lead from soil particles into groundwater 

is unlikely unless the rain falling on the soil is acidic. 

Movement of lead from soil also depends on the type of 

lead compound and on the physical and chemical nature 

of the soil. 

Sources of lead in surface water or sediment include 

deposits of lead-containing dust from the atmosphere, 

wastewater from industries that handle lead (mainly iron 

and steel industries and lead producers), urban runoff, 

and mining piles. 

Sunlight, air, and water can change some lead 

compounds into other forms of lead. However, elemental 

lead cannot be broken down. 

Levels of lead can build up in plants and animals from 

areas where air, water, or soil are contaminated with lead. 

If animals eat contaminated plants or animals, most of 

the lead they eat will pass through their bodies. ◆

7 

Frequency of NPL Sites 

1–8 40–61 

10–19 70–85 

20–39 111 

Derived from HazDat 2006 

Frequency of NPL Sites with Lead Contamination 
8 

EXPOSURE 

TO LEAD 

Lead is commonly found in soil, especially near roadways, older 

houses, old orchards, mining areas, industrial sites, power 

plants, incinerators, landfills, and hazardous waste sites. 

People living near hazardous waste sites can be exposed to lead and chemicals that 

contain lead by breathing air, drinking water, eating food, or swallowing dust or 

dirt that contains lead. Tap water in houses that have lead pipes can contain lead, 

especially if the water is acidic. If you are not certain whether an older building 

contains lead pipes, you should let the water run a while before 

drinking it so that any lead formed in the pipes can be flushed 

out. People living in areas where old houses were painted with 

Approximately 

24 million 

housing units 

have deteriorated 

lead-based paint 

and elevated levels 

of lead-contaminated 

house dust 

lead-based paint can be exposed to higher levels of lead in dust 

and soil. Likewise, people who live near busy highways or on 

old orchard land where lead arsenate pesticides were once used 

can be exposed to higher levels of lead. People who work in jobs 

where lead is used or who have hobbies in which lead is used, 

such as making stained glass, also can be exposed to lead◆

Food can contain small amounts of lead. However, lead solder 

is no longer used in cans, so very little lead is found in food. 

Therefore, the chance of exposure to lead in canned food from 

lead-soldered containers was greatly reduced. (Some other 

nations still use lead-soldered cans.) In the most recent studies, 

lead was not detectable in most foods, and the average dietary 

intake was about 1 microgram of lead (a microgram is a millionth 

of a gram) per kilogram of body weight (μg/kg) per day. Leafy fresh vegetables grown 

in lead-containing soils can have lead-containing dust on them. Lead also can enter 

foods put into improperly glazed pottery or ceramic dishes or into leaded-crystal 

glassware. Illegal whiskey made using stills that contain lead-soldered parts (such as 

truck radiators) also can contain lead. 

In addition, cigarette smoke contains small amounts of lead. Also, children can be 

exposed to lead by putting their hands that have touched lead-containing soil or dust 

into their mouths. 
In general, very little lead is found in lakes, rivers, or 

groundwater used to supply the public with drinking 

water. More than 99% of all publicly supplied drinking 

water contains less than 0.005 parts of lead per million 

parts of water (ppm). However, the amount of lead 

taken into your body through drinking water can be 

higher in communities with acidic water supplies. Acidic 

water makes it easier for the lead found in pipes, leaded 

solder, and brass faucets to be dissolved and to enter 

the water we drink. Public water treatment systems are 

now required to make water less acidic. Plumbing that 

contains lead can be found in public drinking water 

systems and in houses, apartment buildings, and public 

buildings that are more than 20 years old. However, as 

buildings age, mineral deposits form a coating on the 

inside of the water pipes that insulates the water from 

lead in the pipe or solder, thus reducing the amount 

of lead that can leach into the water. Since 1988, 

regulations require that drinking water coolers must 

not contain lead in parts that come into contact with 

drinking water. 

Breathing or swallowing dust and dirt in the air is 

another way you can be exposed to lead. In 1984, 

burning leaded gasoline was the largest source of 

lead emissions. Now, very little lead in the air comes 

from gasoline. Other sources of lead in the air include 

releases to the air from industries involved in iron and 

steel production, lead-acid-battery manufacturing, and 

nonferrous (brass and bronze) foundries. Lead released 

into air also can come from burning of solid waste that 

contains lead, windblown dust, volcanoes, exhaust from 

More than 

99% of all 

publicly supplied 

drinking water 

contains less 

than 0.005 parts 

of lead 

per million parts 

of water. 

9 
10 

workroom air, burning or weathering of lead-painted surfaces, fumes and exhaust 

from leaded gasoline, and cigarette smoke. 

Skin contact with dust and dirt containing lead occurs every day. For example, 

inexpensive cosmetic jewelry pieces sold to the general public might contain high 

levels of lead that can be transferred to the skin during routine handling. However, 

not much lead can get into your body through your skin. 

At home, you or your children might be exposed to lead if you take certain home 

remedy medicines that contain lead compounds. Lead compounds are in some nonWestern cosmetics, such as surma and kohl. Some types of hair colorants, cosmetics, 

and dyes contain lead acetate. Read the labels on hair coloring products, use them 

with caution, and keep them away from children. 

Exposure to lead occurs in many jobs. People exposed at work are usually exposed 

by breathing air that contains lead particles. People who work in lead smelting and 

refining industries, brass/bronze foundries, rubber products and plastics industries, 

soldering, steel welding and cutting operations, battery manufacturing plants, and 

lead compound manufacturing industries can be exposed to lead. Construction 

and demolition workers and workers at municipal waste incinerators, pottery and 

ceramics industries, radiator repair shops, and other industries that use lead solder 

also can be exposed. Painters who sand or scrape old paint can be exposed to lead 

in dust. Between 0.5 million and 1.5 million workers are exposed to lead in the 

workplace every year. In California alone, more than 200,000 workers are exposed to 

lead. Families of workers can be exposed to higher levels of lead when workers bring 

home lead dust on their work clothes. 

You also can be exposed to lead at home if you work with stained glass as a hobby, 

make lead fishing weights or ammunition, or are involved in home renovation that 

involves removing old lead-based paint. ◆
LEAD AND 


THE BODY 


Some of the lead that enters your body 

comes from breathing dust or chemicals 

that contain lead. Once this lead gets into 

your lungs, it travels quickly through 

In adults, your blood to other parts of your body. 

about 94% 

of the total 

amount of lead 

in the body 

is contained 

in the bones 

and teeth. 

About 73% 

of the lead in 

children’s bodies 

is stored in 

their bones 

Particles that are too large to get into your lungs can be 

coughed up and swallowed. You also can swallow lead 

by eating food and drinking liquids that contain it. Most 

lead that enters your body comes through swallowing, 

even though very little of the amount you swallow 

actually enters your blood and other parts of your body. 

The amount that gets into your body from your stomach 

partly depends on when you ate your last meal. It also 

depends on how old you are and how well the lead 

particles dissolved in your stomach juices. Experiments 

using adult volunteers showed that, for adults who 

had just eaten, the amount of lead that got into the 

blood from the stomach was only about 6% of the total 

amount of lead taken in. In adults who had not eaten for 

a day, about 60%–80% of lead in the stomach got into 

their blood. In general, if adults and children swallow 

the same amount of lead, more will enter the blood of 

children than of adults. Children absorb about 50% of 

the lead they ingest. 

Dust and soil that contain lead may get on your skin, but 

only a small portion of the lead will pass through your 

skin and enter your blood if it is not washed off. You can, 

however, accidentally swallow lead that is on your hands 

when you eat, drink, smoke, or apply cosmetics (for 

example, lip balm). More lead can pass through skin that 

has been damaged (for example, by scrapes, scratches, 

11 
and wounds). The only kinds of lead compounds that 

easily penetrate the skin are the additives in leaded 

gasoline. Because leaded gasoline is no longer sold to 

the general public, you are not likely to encounter lead 

that can enter through the skin. 

Shortly after lead gets into your body, it travels in the 

blood to the soft tissues and organs (such as the liver, 

kidneys, lungs, brain, spleen, muscles, and heart). After 

several weeks, most of the lead moves into your bones 

and teeth. In adults, about 94% of lead in the body is 

contained in the bones and teeth. About 73% of lead in 

children’s bodies is stored in their bones. Some lead can 

stay in your bones for decades; however, some lead can 

leave your bones and reenter your blood and organs 

under certain circumstances (during pregnancy and 

periods of breast feeding, after a bone is broken, and 

during advancing age. 

Your body does not change lead into any other form. 

Once it is taken in and distributed to your organs, the 

lead that is not stored in your bones leaves your body in 

your urine or your feces. About 99% of lead taken into 

the body of an adult leaves in the waste within a couple 

of weeks, but in children, only about 32% of the lead 

leaves in the waste. For people who are continuously 

exposed, not all of the lead that enters the body is 

eliminated, which can result in accumulation of lead in 

body tissues, especially bone. ◆

About 99% 

of lead taken 

into the body 

of an adult 

leaves in the 

waste within 

a couple of 

weeks, but in 

children, 

only about 

32% leaves in 

the waste 

12 
HEALTH EFFECTS 

OF EXPOSURE 

The effects of lead are the same whether it enters the body 

through breathing or swallowing. Lead can affect almost every 

organ and system in your body. 

Lead toxicity mainly affects the nervous system. In adults, long-time exposure to lead 

at work has caused low scores on some tests that measure nervous system function. 

Lead exposure can cause weakness in fingers, wrists, or ankles and small increases in 

Health effects of 

lead include 

Nervous system damage 

Reduced kidney function 

Anemia 

Increased blood pressure 

Reproductive problems 

blood pressure, particularly in middle-aged and older people. Lead 

exposure also can cause anemia. At high levels of exposure, lead 

can severely damage the brain and kidneys in adults and in children 

and ultimately cause death. In pregnant women, high levels of 

exposure can cause miscarriage. High-level exposure in men can 

damage the organs that produce sperm. There is evidence that 

these effects may persist beyond childhood. 

Children with high blood lead levels do not have specific 

symptoms. However, health workers can find out whether a child 

may have been exposed to harmful levels of lead by taking a blood 

sample. They can also find out how much lead is in a child’s bones 

by taking a special type of x-ray of the finger, knee, or elbow. This 

type of test, however, is not routine. 

We have no certain proof that lead causes cancer in humans. 

Kidney tumors have developed in rats and mice that had 

been given large amounts of some lead compounds. The U.S. 

Department of Health and Human Services has determined that 

lead and lead compounds are reasonably anticipated to be human carcinogens based 

on limited evidence from studies in humans and sufficient evidence from studies 

in animals, and EPA has determined that lead is a probable human carcinogen. The 

International Agency for Research on Cancer (IARC) has determined that inorganic 

lead is probably carcinogenic to humans. IARC determined that the carcinogenicity in 

13 
humans of organic lead compounds cannot be classified 

because evidence from studies in humans and animals 

is inadequate. ◆

The effects of 

lead are the 

same whether 

it enters the 

body through 

breathing or 

swallowing 

14 
LEAD AND 


CHILDREN 


Studies by CDC show that the levels of lead in the blood of 

U.S. children have been getting lower. 

The reason for decreasing blood lead levels is decrease in use. For example, lead is 

banned from gasoline, residential paint, and solder used for food cans and water 

pipes. However, about half a million U.S. children 1–5 years old are believed to have 

levels equal or greater than 5 micrograms of lead per deciliter of blood (μg/dL), the 

level used to identify children with blood lead levels that are much higher than most 

children’s levels. 

Compared with adults, children are more easily exposed to lead. Children are exposed 

throughout their lives. They can be exposed in the womb if their mothers have lead 

in their bodies. Babies can swallow lead when they breast feed or eat foods and drink 

water that contains lead. Babies and children can swallow and breathe lead in dirt, 

dust, or sand while they play on the floor or ground. The dirt or dust on children’s 

hands, toys, and other items can have lead particles in it. In some cases, children 

swallow nonfood items, such as paint chips, which can contain very large amounts of 

lead, especially in and around older houses that were painted with lead-based paint. 

The paint in these houses often chips off and mixes with dust and dirt. Some old paint 

1997 2004 

2011 

Blood Lead Levels 

At or Above 10 μg per dL 

As Percent of Children Tested 

0.126%–0.2% 

0.201%–5% 

5.001%–15% 

15.001%–25% 

25.001%–96% 

Not Available 

http://www.cdc.gov/nceh/lead/data 

15 
contains as much as 50% lead. Also, compared 

with adults, a bigger proportion of the amount of 

lead swallowed enters the blood of children. 


Children are more sensitive than adults to the 

health effects of lead. No safe level of lead in blood 


has been determined for children. Lead affects 


children in different ways depending on how 


much lead they swallow. A child who swallows
 

large amounts of lead can develop anemia, kidney 


damage, colic (severe “stomach ache”), muscle 

weakness, and brain damage, which ultimately can 

kill the child. In some cases, the amount of lead in 

the child’s body can be lowered by giving him or 

her drugs that help eliminate lead from the body. 

If a child swallows smaller amounts of lead, such as 

dust containing lead from paint, much less severe 


but still important effects on blood, development, 


and behavior can occur. In this case, recovery is 


likely once the child is removed from the source
 

of lead exposure, but there is no guarantee that 


the child will completely avoid all long-term America’s Children and the Environment, Third Edition 

effects of lead exposure. At still lower levels of 

exposure, lead can affect a child’s mental and 

physical growth. Fetuses whose mothers had a lot of lead in their bodies can be born 

prematurely and have lower weights at birth. Exposure in the womb, in infancy, or in 

early childhood also can slow mental development and cause lower intelligence later 

in childhood. Evidence shows that these effects might persist beyond childhood. 

Children with high levels of lead in their blood do not have specific symptoms. 

However, health workers can find out whether a child might have been exposed to 

harmful levels of lead by taking and testing a blood sample. They can also find out 

how much lead is in a child’s bones by taking a special type of x-ray of the finger, 

knee, or elbow. This type of test, however, is not routine. ◆

16 

Lead in children ages 1 to 5 years: 

Median and 95th percentile concentrations in blood, 1976–2010 

30 

25 


95th percentile 

Median 

Concentration of lead in blood (μg/dL) 

20 

15 

10 

5 

0 

1976–19801988–19911991–19941999–20002001–20022003–20042005–20062007–20082009–2010 

The EPA reports that the largest decrease in blood lead levels was 

observed between 1970 and 1990, when lead was removed from 

gasoline. Additional decreases in blood lead levels from 1990–2000 

and 2009–2010 are attributed to the focus on removing lead-based 

paints in homes. 

Data: Centers for Disease Control and Prevention, National Center for Health 


Statistics and National Center for Environmental Health, National Health and 


Nutrition Examination Survey 
17 

REDUCING RISK 

OF EXPOSURE 

If your doctor finds that you have been exposed to substantial 

amounts of lead, ask whether your children might also have 

been exposed.Your doctor might need to ask your state health 

department to investigate.. 

The most important way your family can lower exposures to lead is to know about 

the sources of lead in your home and avoid exposure to these sources. Some homes 

or day-care facilities may have more lead in them than others. Families who live in 

or visit these places can be exposed to higher amounts of lead. 

These places include homes built before 1978 that might have 

been painted with lead-based paint. If you are buying a home 

that was built before 1978, you might want to know whether 

it contains lead-based paint. Federal government regulations 

require a person selling a home to tell the real estate agent or 

person buying the home of any known lead hazards on the 

property. Adding lead to paint is no longer allowed. Houses built 

before 1978 still might have lead-based paint on interior walls, 

floors, ceilings, and window sills or on the outside walls of the 

house. Even if a previous owner scraped off the paint, paint chips 

and lead-containing dust still could be in the yard soil. Decaying, 

peeling, or flaking paint can introduce lead into household dust, 

so such areas should be repainted. In some states, homeowners 

can have the paint in their homes tested by their local health departments. The 

National Lead Information Center (1-800-424-5323) lists approved risk assessors 

(people who are qualified to assess the possible risks of a site) and of approved 

testing laboratories (for soil, paint, and dust). 

Sanding surfaces painted with lead-based paint or using heat to peel the paint can 

expose you to high levels of lead. Many cases of lead poisoning have resulted from 

do-it-yourself home renovations. Therefore, any renovations should be performed by 

a licensed contractor who will minimize exposure to household members. The area 

being renovated should be isolated from the rest of the house to lessen exposure 

to lead-containing dust. The federal government requires that contractors who test 
18 

for or remove lead must be certified by the EPA or an EPA-approved state program. 


Ask to see certifications of potential contractors. Your state health department or 


environmental protection division can help identify certified contractors 


for you. Additional information can be found at http://www2.epa.gov/
 

lead/evaluating-and-eliminating-lead-based-paint-hazards#contractor. 

You can lower the possibility of your children swallowing paint chips by 

discouraging them from chewing on or putting these painted surfaces 

in their mouths and by making sure that they wash their hands often, 

especially before eating. Areas where levels of lead in dirt and dust might 

be especially high are near old houses, highways, or old orchards. Some 

children eat dirt (the term for this activity is pica). Discourage your children 

from eating dirt and from participating in other hand-to-mouth activities. 

Non-Western folk remedies used to treat diarrhea or other ailments can 

contain substantial amounts of lead. Examples of these include Alarcon, 

Ghasard, Alkohl, Greta, Azarcon, Liga, Bali Goli, Pay-loo-ah, Coral, and 

Rueda. If you give these substances to your children or if you are or nursing 

or pregnant, you could expose the children or fetus to lead. You should 

know the ingredients of any medicines that you or your children use. 

Older homes that have plumbing with lead can have higher amounts of lead in 

drinking water. Interior plumbing installed before 1930 is most likely to contain 

high levels of lead. Copper pipes now have replaced lead pipes in most residential 

plumbing. You cannot see, taste, or smell lead in water, and boiling your water will not 

get rid of lead. Therefore, if your house has a water-lead problem, EPA recommends 

that anytime you have not used water in a particular faucet for 6 hours or longer, you 

should flush the cold water pipes by running water until it is cold (5 seconds– 

2 minutes). Because lead dissolves more easily in warm water than in cold water, 

you should use only cold water for drinking, cooking, and preparing baby formula. 

Contact your local health department or water supplier to find out about testing 

your water for lead. If these tests show a major presence of lead, consult your water 

supplier or local health department about possible solutions. 
If you work in a place where lead is used, you can bring 

lead home in the dust on your hands or clothes. Lead 

dust is likely to be found in places where lead is mined 

or smelted; where car batteries are made or recycled; or 

where electric cable sheathing, crystal glass, or certain 

types of ceramic pottery are made. Pets can bring lead 

into the home in dust or dirt on their fur or feet if they 

spend time in places that have high levels of lead in 

the soil. 

In children, swallowing lead in house dust or soil is a 

very important path of exposure. Regularly washing the 

hands and face to remove lead dusts and soil, especially 

before meals, can lessen the possibility that lead on 

the skin will be accidentally swallowed during eating. 

Your family can lower exposure by regularly cleaning 

the home of dust and tracked-in soil. Door mats can 

help decrease the amount of soil tracked into the home; 

removing your shoes before entering the home also 

helps. By planting grass and shrubs over areas of bare 

soil in the yard, you can lower contact by children and 

pets with soil and lower the amount of soil tracked into 

the home. 

19 

Good nutrition 

lowers the 

amount of 

swallowed 

lead that 

passes to the 

bloodstream 

and might lower 

some of the 

toxic effects 

of lead 
If you are exposed to lead dusts at work, 

you can keep these dusts away from your 

children by showering and changing your 

clothes before leaving work and by bagging 

your work clothes before you bring them 

home for cleaning. Proper ventilation and 

cleaning during and after hobby activities, 

home or auto repair activities, and hair 

coloring with products that contain lead will 

decrease the possibility of exposure. 

Dust that contains lead can be deposited 

on plant surfaces, and the roots of some 

edible plants can take up lead from the 

soil. Therefore, home gardening also can 

contribute to exposure if the produce is 

grown in soils that have high concentrations 

of lead. To remove surface deposits of 

lead, you should wash vegetables very well before eating them. Certain hobbies and 

home or car repair activities like radiator repair also can add lead to the home. These 

activities include soldering glass or metal, making bullets or slugs, or glazing pottery. 

Some types of paints and pigments that are used as facial make-up or hair coloring 

contain lead. Cosmetics that contain lead include surma and kohl, which are popular 

in some Asian countries. Read the labels on hair coloring products, and keep hair 

dyes that contain lead acetate away from children. Do not allow children to touch hair 

that has been colored with lead-containing dyes or any surfaces that have come into 

contact with these dyes because lead compounds can rub off onto their hands and be 

transferred to their mouths. 

Children need to have proper nutrition and eat a balanced diet of foods that supply 

adequate amounts of vitamins and minerals, especially calcium and iron. Good 

nutrition lowers the amount of swallowed lead that passes into the bloodstream and 

might lower some of the toxic effects of lead. ◆

20 
EXPOSURE 

TESTING 

The amount of total lead in the blood can be measured to 

determine whether you have been exposed to lead. 

This test shows whether you have been recently exposed to lead. Lead can be 

measured in teeth or bones by x-ray techniques, but these methods are not widely 

available. These tests show long-term exposures to lead. The primary screening 

method is measurement of lead in blood. Exposure also can be evaluated by 

measuring erythrocyte protoporphyrin (EP) in blood samples. EP is a part of red blood 

cells that increases when the amount of lead in the blood is high. However, the EP 

level is not sensitive enough to identify children who have elevated blood lead levels 

below about 25 μg/dL. These tests usually require special analytical equipment that 

is not available in a doctor’s office, but your doctor can draw blood samples and send 

them to appropriate laboratories for analysis. ◆

21 
22 

GOVERNMENTAL 

REGULATIONS AND 

RECOMMENDATIONS 

The federal government develops regulations and 

recommendations to protect public health. Regulations can 

be enforced by law. 

The EPA, the Occupational Safety and Health Administration (OSHA), and the Food 

and Drug Administration (FDA) are some federal agencies that develop regulations 

for toxic substances. Recommendations differ from regulations in that they provide 

valuable guidelines to protect public health but cannot be enforced by law. The 

Agency for Toxic Substances and Disease Registry (ATSDR) and the National Institute 

for Occupational Safety and Health (NIOSH)—both part of CDC—are two federal 

organizations that develop recommendations for toxic substances. 

Regulations and recommendations can be expressed as “not-to-exceed” levels. This 

means that levels of a toxic substance in air, water, soil, or food that are not higher 

than a critical value that is usually based on levels that affect animals; these levels 

are then adjusted to levels that will help protect humans. Sometimes these not-toexceed levels differ among federal agencies because the exposure times (an 8-hour 

workday or a 24-hour day), animal studies, or other factors they use differ. 
23 

These agencies update their recommendations and regulations as more information 

becomes available. For the most current information, check with the federal agency 

or organization that provides it. 

The most important step parents, doctors, and others can take is to prevent lead 

exposure before it occurs. CDC recommends focusing on primary prevention of lead 

exposure. Experts now use a reference level of 5 micrograms per deciliter to identify 

children with blood lead levels that are much higher than most children’s levels. This 

new level is based on the U.S. population of children ages 1-5 years who are in the 

highest 2.5% of children when tested for lead in their blood. This reference value 

is based on the 97.5th percentile of the National Health and Nutrition Examination 

Survey (NHANES)’s blood lead distribution in children. CDC will update the reference 

value every four years using the two most recent NHANES surveys. Chelation 

therapy is recommended for children with levels above 45 μg/dL. Medicaid and most 

private health insurance plans cover blood tests to measure lead in children’s blood. 

EPA requires that the concentration of lead in air be no higher than 1.5 micrograms 

per cubic meter (μg/m3

) averaged over 3 months. The Clean Air Act Amendments 

(CAAA) of 1990 banned the sale of leaded gasoline as of December 31, 1995. 

Under the Lead Copper Rule, EPA requires testing of public water systems. If more 

than 10% of the samples at homes contain lead levels higher than 0.015 milligrams 

per liter of water (mg/L), actions must be taken to lower these levels. Testing for 

lead in drinking water in schools is not required unless a school is regulated under 

a public water system. The 1988 Lead Contamination Control Act (LCCA) was 

created to help reduce lead in drinking water at schools and day-care centers. The 

LCCA created lead monitoring and reporting requirements for schools and the 

replacement of fixtures that contain high levels of lead. However, the provisions in 

the LCCA are not enforceable by the federal government, and individual states can 

voluntarily comply with these provisions or create their own. 

To help protect young children, the Consumer Product Safety Commission requires 

that the concentration of lead in most paints available through normal consumer 

channels be not more than 0.06%. The Federal Hazardous Substance Act bans 

children’s products containing hazardous amounts of lead. 

The U.S. Department of Housing and Urban Development (HUD) develops 

recommendations and regulations to prevent exposure to lead. HUD requires that 

federally funded housing and renovations, public and Indian housing be tested for 

lead-based paint hazards and that such hazards be fixed by covering or removing 

the paint. EPA and HUD have determined that paint should be removed or otherwise 

treated if it contains lead levels equal to or more than 1.0 milligram of lead per 
24 

square centimeter (mg/cm2) of surface area on interior or exterior surfaces of 

dwellings. HUD is determining the best ways of covering or removing lead-based 

paint in housing. 

EPA has developed standards for lead-paint hazards, lead in dust, 

and lead in soil. To educate parents, homeowners, and tenants 

about lead hazards, lead poisoning prevention in the home, and 

the process of decreasing lead, EPA has published several general 

information pamphlets. Copies of these pamphlets are available 

from the National Lead Information Center or from various 

Internet sites, including http://www2.epa.gov/lead. 

OSHA regulations limit the concentration of lead in workroom 

air to 50 μg/m3

 for an 8-hour workday. If a worker has a blood 

lead level of 50 μg/dL or higher, then OSHA requires that the 

worker be removed from the workroom where he or she is being 

exposed to lead. 

FDA includes lead on its list of poisonous and harmful substances. 

FDA considers food packaged in cans that contain lead solders 

to be unsafe. For example, tin-coated lead foil has been used 

to cover the cork and neck areas of wine bottles for decoration 

and to prevent insect infestations. Because lead could become a 

component of the wine, the use of such foil violates the Federal 

Food, Drug, and Cosmetic Act. FDA has determined that several 

ingredients, such as food dyes, that are directly added to human 

food are “generally recognized as safe” when used in accordance with current good 

manufacturing practices. Some of these ingredients contain allowable concentrations 

of lead that range from 0.1 ppm to 10 ppm. ◆
25 

ADDITIONAL 


INFORMATION 


If you have more questions or concerns, please contact 

your community or state health or environmental quality 

department, or contact ATSDR at the address and phone 

number below. 

ATSDR also can tell you the location of occupational and environmental health clinics. 

These clinics specialize in recognizing, evaluating, and treating illnesses that result 

from exposure to hazardous substances. 

Agency for Toxic Substances and Disease Registry 

Division of Toxicology and Human Health Sciences 

1600 Clifton Road NE, Mailstop F-57 

Atlanta, GA 30333 

Toll-free information and technical assistance: 1-800-CDCINFO (1-800-232-4636) 

Sources 

ATSDR Toxicological Profile for Lead 

http://www.atsdr.cdc.gov/toxprofiles/TP.asp?id=96&tid=22 

CDC National Center for Environmental Health, Lead Program 

http://www.cdc.gov/nceh/lead 

Environmental Protection Agency, Lead Program 

http://www2.epa.gov/lead 
something like: A publication from the Centers for 

Disease Control and Prevention

ATSDR TOXZINE A publication of CDC/ATSDR

CS242227-A