Re-thinking Our Approach to Lead Exposure in Children

Lead exposure in children has no safe level — and the science on that point is now settled. For decades, the public health response was reactive. The plan was simple: wait for a child's blood lead level to cross a set line, then step in. That approach is gone. Doctors and scientists now agree: the only thing that truly works is to stop exposure before it happens. This change matters for parents, tenants, and landlords. It matters even more in a city like New York, where old housing puts children at risk every day.

Lead exposure is not a problem of the past. It is still in NYC's aging buildings, in soil, in water lines, and in everyday products. Below, we explain what changed in the science. We cover how children are exposed, what lead does to a growing body, what New York law requires of landlords, and what families can do right now. The Orlow Firm has represented children harmed by lead poisoning for over 40 years. Understanding the issue clearly is the first step toward protecting a child.

Is There a Safe Level of Lead Exposure in Children?

There is no safe level of lead exposure in children. The CDC's current blood lead reference value is 3.5 micrograms per deciliter (µg/dL). That number is not a safety line. It simply flags children with the highest blood lead levels compared to other kids. Even low-level exposure can cause permanent brain damage, learning problems, and behavior problems.

This is a real change from the old way of thinking. For years, a blood lead level of 10 µg/dL was treated as the "blood lead level of concern." That was the point at which doctors stepped in. The CDC has since dropped that idea. In 2012, the agency switched to a reference value instead of a level of concern. Then in October 2021, it lowered that reference value from 5 µg/dL to 3.5 µg/dL. The change was based on 2015–2018 National Health and Nutrition Examination Survey (NHANES) data (CDC: Updates to the Blood Lead Reference Value).

The difference matters. The reference value does not mark where harm begins. It is a statistical marker. It flags children in roughly the top 2.5% of blood lead levels nationwide, signaling a need to act. A child can be harmed by lead well below this number. The reference value just helps public health officials send prevention efforts to the children and communities hit hardest.

Why "No Safe Level" Changes Everything About Childhood Lead Poisoning Prevention

Lead does nothing useful in the human body. It is a whole-body toxin. Once it is in a child, its effects reach far past the brain. Still, the brain is where the most studied and most serious harm happens.

Research links childhood lead exposure to reduced IQ, attention problems, learning disabilities, and behavior disorders. This holds true even at levels once thought to be acceptable. The harm is not limited to thinking and learning. Studies tie exposure to damage in the heart, the immune system, and the endocrine system. The endocrine system controls the glands that release hormones into the blood. When it is disrupted, a child's overall development can suffer.

The hardest part is this: damage to the central nervous system usually cannot be undone. Removing the source and lowering a child's blood lead level can stop new harm. But it cannot reverse harm that has already happened. Special learning programs can help a lead-exposed child cope with school. They do not fix the underlying injury. That is why the prevention-first model has taken hold. By the time a blood test shows a problem, some harm may already be done.

Exposure can start before birth. A mother's own past exposure can leave lead stored in her bones. During pregnancy, that lead can move back into her blood and cross the placenta. There it can affect the baby's brain as it forms. For this reason, the CDC recommends screening for pregnant and breastfeeding women in certain cases.

How Children Are Exposed: Sources in the City

The CDC calls lead a "multi-media pollutant." That means it reaches children through several paths at once. Parents in older NYC neighborhoods need to know those paths.

Lead-based paint is the main source. According to the EPA and HUD's American Healthy Homes Survey II, approximately 34.6 million U.S. homes contain lead-based paint applied before 1978. Homes built before 1978 carry the greatest risk. That is the year residential lead paint was restricted. The danger is highest in housing built before 1960, which describes much of New York's older building stock. Low-income households are more likely to live in homes with lead paint hazards.

Lead dust is often the real culprit. Painted surfaces break down over time. They also get disturbed by renovation, or they rub against each other at friction points like windows and doors. All of this releases fine dust you cannot see. Young children swallow it through normal hand-to-mouth behavior. That is why lead poisoning often happens in homes that look perfectly clean to a parent.

Lead reaches children in two other ways at home. One is contaminated soil near older buildings. There, exterior paint and decades of leaded gasoline have left residue behind. The other is water that passes through old plumbing and fixtures. Beyond the home, consumer products are still a source. The list includes lead-glazed ceramics, some imported toys and children's jewelry, and cosmetics such as kohl and surma. It also includes folk remedies, herbal medicines, and some imported spices.

Renovation deserves special attention. Disturbing old paint without the right controls can flood a home with lead dust. In some communities, home renovations are a significant source of childhood lead poisonings. The EPA's Lead Renovation, Repair and Painting (RRP) rule sets a clear standard here. Anyone paid to do work that disturbs painted surfaces in pre-1978 homes, childcare facilities, or preschools must be certified in lead-safe work practices (EPA: Lead Renovation, Repair and Painting Program).

Finally, some children should be tested when they arrive in the United States. This includes immigrant, refugee, and internationally adopted children. In their home countries, they may have been exposed to lead in medicines, cosmetics, toys, or ceramics.

Health Consequences: What Lead Exposure Does to a Growing Child

Lead's reach is so broad that it helps to look at the harm system by system.

• Brain and nervous system: This is the most serious and best-documented harm. Lead is linked to shorter neural connections, reduced brain volume, lower IQ, and lasting attention and behavior problems.
• Cardiovascular system: Newer research ties early lead exposure to higher blood pressure and greater heart risk later in life.
• Immune system: Lead can disrupt the body's normal immune response.
• Endocrine system: Lead can interfere with the hormone-making glands that control growth and development.
• Kidneys: Kidney damage from lead is more reversible than brain damage, but it is still serious.

Lead also has a long memory in the body. Large stores can stay in a child's bones for decades. They can release back into the blood much later, including during pregnancy or menopause. This creates a long-term health risk that outlasts the original exposure.

One newer area of study is epigenetics. These are the mechanisms that control how genes are expressed without changing the DNA itself. Research suggests lead can change DNA methylation. In theory, those changes could pass to the next generation and affect how the brain and organs develop. This is still emerging research, not settled science. But it adds urgency to the prevention-first approach.

One of the most dangerous things about low to moderate lead exposure is that there are often no symptoms. A child can be building up harm with no visible sign. That is why routine blood testing is the standard of care, rather than waiting for symptoms.

NYC Law: What Landlords Are Required to Do

New York City has among the strictest lead-paint protections in the country. They place clear, enforceable duties on landlords. Tenants who know these rules are in a far better spot to protect their children.

Local Law 1 of 2004 is also called the New York City Childhood Lead Poisoning Prevention Act. It applies to buildings with three or more units built before January 1, 1960. It also applies to pre-1978 buildings where the owner knows lead paint is present. The rules kick in when a child under age 6 lives in a covered unit. They also apply when such a child regularly spends 10 or more hours a week there. In that case, the landlord must:

• Conduct yearly visual inspections for peeling paint and other hazards.
• Fix all lead-based paint hazards found.
• Use lead-safe work practices during any repair or renovation.
• Give tenants yearly written notice about lead paint risks.

Fines for breaking these rules can reach $10,000. A landlord cannot escape blame by claiming "I didn't know." Once lead paint is found in a covered building, ignorance does not protect the owner from liability (NYC HPD: Lead-Based Paint).

Local Law 123 of 2023 strengthened these duties. It became enforceable on September 1, 2024. It targets door and window friction surfaces, a leading source of lead dust, in buildings with young children. Say a child under 6 already lived in a unit as of January 1, 2025. The owner must fully fix the friction surfaces by July 1, 2027. If a child under 6 moves in after that date, the owner has three years from move-in to do the work.

Owners had another deadline too. They had to complete X-ray fluorescence (XRF) testing of all common areas by August 2025. They must also share those testing records on request.

One principle ties all of this together. New York courts have applied it consistently: a landlord's duty to keep housing safe is nondelegable. An owner cannot dodge responsibility by pointing to a renovation crew or a management company. In our experience, courts have held both landlords and the companies they hire accountable when a child is poisoned.

Here is what that can look like in real life. In one matter our firm handled, a child developed elevated lead levels after a landlord and maintenance company failed to maintain the apartment. The child recovered $3,750,000. That result reflected how seriously the law treats this kind of negligence. Prior results do not guarantee a similar outcome.

Prevention: What Families Can Do to Reduce Lead Exposure in Children

Because the harm from lead is largely permanent, prevention is everything. Several concrete steps are within a family's control.

Get your child tested. A blood test is the only way to know a child's lead level. In New York City, pediatricians must screen children at ages 1 and 2. They do more testing when risk factors are present. The CDC also recommends testing immigrant and refugee children when they arrive.

Report hazards to your landlord in writing. Written notice that a child under 6 lives in the unit puts the landlord on notice under NYC law. It also starts the clock to inspect and fix the problem. Keep a copy of everything you send.

Know your building's age. Buildings built before 1960 carry the highest risk. You can review a building's records through HPD at nyc.gov/hpd.

Support your child's nutrition. A diet rich in calcium, iron, and vitamin C can lower how much swallowed lead the body absorbs. Iron deficiency, in particular, is linked to higher blood lead levels.

Reduce dust exposure. Wet-mop floors and windowsills often. Wash children's hands and toys often. Avoid tracking outdoor soil indoors.

Be careful about renovation. Do not sand or scrape painted surfaces in a pre-1978 building without an EPA-certified lead-safe contractor. Bad renovation work is one of the fastest ways to create a serious hazard.

Confirm the cleanup worked. A child's blood test alone does not prove that cleanup succeeded. Lead can linger in dust long after repairs. Testing the dust and soil is a more reliable way to know a hazard is truly gone.

The Persistence of Racial and Economic Disparities

Average blood lead levels have fallen across the country in recent decades. Even so, the burden of lead exposure has never been shared equally. Non-Hispanic Black children and children in low-income households still have higher blood lead levels on average.

These gaps come from differences in housing quality, access to good nutrition, and environmental conditions. In New York City, the oldest and most hazardous housing often sits in neighborhoods where lower-income families live. That geography is exactly why local enforcement and landlord accountability matter so much. The law is strongest where it is actually applied. Holding negligent property owners responsible is part of how that protection becomes real for the families who need it most.

Frequently Asked Questions About Lead Exposure in Children

What is the current CDC blood lead reference value for children?

As of October 2021, the CDC's blood lead reference value is 3.5 micrograms per deciliter (µg/dL), down from the previous 5 µg/dL. It is based on NHANES data from 2015–2018 and identifies children with the highest blood lead levels compared to their peers. It is not a line below which lead is safe — harm can occur at lower levels.

Can lead poisoning be reversed?

Damage to the central nervous system from lead usually cannot be reversed. Lowering a child's blood lead level and removing the source stops further harm but cannot undo brain damage that has already happened. That is why preventing lead exposure in children, rather than treating it after the fact, is the priority for doctors and public health officials.

How long does lead stay in a child's body?

Lead can stay stored in bone for decades and is slowly released back into the blood over time. It can resurface during periods of physical stress such as pregnancy. Because of this, a single normal blood test does not guarantee that a past exposure hazard is fully resolved. Long-term monitoring may be warranted.

Is my NYC landlord required to fix lead paint?

Yes, in many cases. Under Local Law 1, landlords of pre-1960 multiple dwellings must inspect each year, fix lead hazards, use lead-safe work practices, and give written notice when a child under 6 lives in the unit. Local Law 123 adds rules for window and door friction surfaces. A landlord's lack of knowledge is not a defense once lead paint is present in a covered building.

At what age are children most at risk from lead exposure?

Young children under 6 are most at risk. Their brains and nervous systems are still developing, they absorb lead more easily than adults, and their normal hand-to-mouth behavior makes them more likely to swallow lead dust. Lead exposure in children can also begin before birth, through lead stored in the mother's bones that crosses the placenta during pregnancy.

Sources & Official Resources

Federal Health & Environmental Standards

1. CDC: Updates to the Blood Lead Reference Value
2. EPA: Lead Renovation, Repair and Painting Program
3. EPA: How Many Homes Still Contain Lead-Based Paint

NYC Laws & Landlord Requirements 4. NYC HPD: Lead-Based Paint 5. NYC HPD: Local Law 123 of 2023 (PDF)

Helpful Resources for Tenants 6. NYC HPD: Penalties and Fees

Contact The Orlow Firm

If your child has been diagnosed with an elevated blood lead level, your family may have legal rights. Those rights can run against a negligent landlord, property owner, or management company. New York law places a clear, nondelegable duty on those owners to keep housing safe. When they fail to meet it, the law lets injured children and their families seek accountability.

The Orlow Firm has handled lead poisoning cases for over 40 years. We have recovered millions of dollars for children harmed by lead in New York City. Our work in this area reflects decades of experience. It is led by attorneys including Adam Orlow, a former President of the Queens County Bar Association.

Call (646) 647-3398 for a free consultation. We work on contingency, so you pay nothing unless we recover for you.

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This article provides general information and is not legal advice. Every case is different. Contact an attorney to discuss your specific situation.