Lead in Blood: CDC Rejects “Elevated,” Keeps BLRV

What Happened

On its Childhood Lead Poisoning Prevention News and Features webpage, CDC posted an article on July 29, 2026, titled “Why CDC Avoids the Term ‘Elevated’ for Blood Lead Levels.” The webpage links to a fact sheet providing the agency’s recommended terminology when discussing children’s blood lead levels. It appears to be the agency’s first new post on this News and Features webpage since 2023.

CDC says its bottom line is that “we avoid the term ‘elevated’ because it can unintentionally suggest that some blood lead levels are safe. There is no scientific basis for that idea. Plain, accurate language helps parents understand the risk, helps partners communicate more clearly, and keeps the focus where it belongs: preventing lead exposure before it harms a child.” The agency explains that “in everyday health communication, the term ‘elevated’ often implies a scale with a safe range, a caution range, and a high range. That framing may work for some health measures, but it does not work for lead.”

CDC claims its Blood Lead Reference Value (BLRV) “helps identify children whose blood lead levels are higher than most children’s levels. A result below the BLRV does not mean there was no exposure or no risk.”¹ The agency offers ten alternative descriptions.²

• “Lead in the blood.”
• “A blood lead level higher than most children’s.”
• “A blood lead level that may harm health.”
• “Blood lead levels greater than ____ µg/dL.”
• “Blood lead levels greater than most children.”
• “Blood lead levels above CDC’s BLRV.”
• “Blood lead levels above the state’s level that triggers follow-up care.”
• “No safe level of lead in blood has been identified.”
• “Even low levels of lead can harm a child’s health.”
• “The blood lead reference value is not a safety threshold.”

Why It Matters

Healthcare professionals look to CDC to provide guidance for their actions and communications designed to protect children from lead. Often CDC requires that state and local health departments that they fund follow this guidance as a condition for accepting the resources.

Beyond funding, the terms that government agencies use to describe lead exposure can significantly impact the actions that people, whether parents, healthcare professionals, or regulators, take. The goal is to strike the right balance so that appropriate action—not overreaction or underreaction—is taken. 

The challenge is particularly difficult when the lead exposure is expressed as a numerical level of lead in blood, dust, soil, water, food, or paint. People need context to make sense of it, especially with unfamiliar units like micrograms.

CDC’s Scientific Advisors Raised Concerns with BLRV in 2017

As described in its fact sheet, CDC’s terms for blood lead levels have changed over the years. From 1978 to 1991, CDC used “elevated blood lead level” (EBLL). From 1991 to 2012, it used “level of concern” to describe levels over 10 µg/dL. This term was broadly criticized as implicitly suggesting there were no concerns below that level.

In 2012, CDC shifted to the current term of BLRV. Five years later, in January 2017, CDC’s Board of Scientific Counselors (BSC)³ considered lowering the BLRV to 3.5 µg/dL.⁴ As part of the discussion, CDC asked the BSC to evaluate the BLRV terminology and whether to switch to “action level.”

The BSC indicated⁵ that BLRV was a vague term that was not helpful because it had little meaning. It recommended that CDC move away from BLRV but not replace it with “action level” because some may find it “confusing and difficult to interpret.” However, it advised CDC to use action level to “provide clear guidance for the pediatric community,” anticipating that “pediatricians would be able to inform parents that no safe level of lead exposure exists, but specific ‘actions’ should be taken at a certain BLL.”

CDC Bypassed LEPAC and Ignored EPA and HUD Regs Using the Term

CDC issued its guidance apparently without raising the issue to the federal Lead Exposure and Prevention Advisory Committee (LEPAC), which Congress established to “review and identify best practices, or the need for best practices, regarding lead screening and the prevention of lead poisoning,” and to “identify effective services, including services relating to healthcare, education, and nutrition for individuals and communities affected by lead exposure and lead poisoning.” LEPAC last met in December 2024.

In its guidance, CDC failed to even mention that both EPA and HUD use the term “elevated blood lead level” (EBLL) in their regulations here and here. The regulations were first adopted in 1996 and 1999 respectively when CDC used the term “level of concern” to describe blood lead levels.

As a result, CDC provided no guidance to help public health professionals attempting to reconcile the conflicting terms of EBLL and BLRV in their risk assessments, documents that are shared with parents and healthcare providers. Note that in most federally subsidized property, HUD mandates an environmental investigation be conducted when the EBLL is exceeded and that interim controls be conducted when lead-based paint hazards are identified.

Our Take

We appreciate CDC’s concerns with the term EBLL but agree with its BSC that the term BLRV is flawed and needs to be replaced. Those flaws push people to use EBLL as an alternative. CDC’s approach of supplementing BLRV with a series of phrases does not resolve the underlying problem; it is simply putting lipstick on a pig.

The reality is that the BLRV represents an unusually high blood lead level—the top 2.5% of young children—that warrants child-specific action. Even though previous generations considered those levels to be tolerable, we now know they are not. The challenge is finding a term that conveys that need for action without freaking out parents and caregivers.

More broadly, we do not understand why CDC:

• Prioritized this issue among its many undone tasks.
• Offered plain language alternatives that still use the term BLRV.
• Bypassed LEPAC which Congress established to evaluate best practices.
• Provided no guidance for health departments that need to reconcile the BLRV with HUD’s and EPA’s use of the EBLL term.

We encourage CDC to:

• Withdraw its article and conduct a more rigorous analysis that is grounded in evidence and reviewed by LEPAC, starting with BSC’s recommendations.
• Consider the term “action level” since FDA now uses it to describe baby food with high levels of lead and EPA has expanded its use to dust-lead levels and is expected to take a similar approach with anticipated soil-lead standards. This broader, more consistent usage may have resolved some of BSC’s concerns that action level is confusing and difficult to interpret.
• Adopt EPA’s approach to dust-lead hazards and designate any measurable level of lead in blood a “blood lead hazard.”

Work with HUD and EPA to provide guidance to risk assessors regarding the term EBLL, even if it means updating their regulations.

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1. CDC provides recommended actions based on BLL based on whether the levels are greater or less than 3.5 µg/dL. It also explains what additional steps should done if levels are between 3.5 to 19, between 20 and 44, or greater than 45 µg/dL. ↩︎
2. The agency provides the first three on its webpage as plain alternatives and the last three as “what partners can say.” The middle four are described in the fact sheet as “alternative terms for discussing children’s blood lead levels.  ↩︎
3. We are posting the minutes that we downloaded years ago. CDC’s webpage for the BSC says that BWC meeting minutes are at https://www.cdc.gov/orr/scientific-counselors/index.html. Unfortunately, that webpage is apparently not functioning. ↩︎
4. The BSC recommended that CDC lower the BLRV from 5 to 3.5 µg/dL. CDC took that action almost five years later, on October 28, 2021. ↩︎
5. The BSC said, “the terminology should be changed from ‘reference value,’ but ‘action level’ should not serve as the substitute. EPA has used ‘action level’ for quite some time, but this language is still confusing and difficult to interpret.” It recommended that “‘action level’ should replace ‘reference value’ to provide clear guidance to the pediatric community. With this terminology, for example, pediatricians would be able to inform parents that no safe level of lead exposure exists, but specific ‘actions’ should be taken at a certain BLL. Moreover, the use of specific language is important to both the lay public and professional community.” ↩︎