Risk Factors and International Adoption

Key points

  • Children who have been adopted from other countries are considered high risk for lead exposure.
  • Parents, adoption service providers, and healthcare providers can protect children from lead exposure.
A woman, young boy and a man with moving boxes and a drawing of furniture in the background.


The risk for lead exposure is much higher in many countries from which children are adopted than in the United States.123 Each country sets its own policies on regulations for environmental exposures, and some countries have stronger regulations than others.

Children's exposure to sources of lead varies by country.123 Even within a country, lead exposure may vary by racial/ethnic group or income level.

Children from outside the United States can be exposed to lead from:

  • Ceramic or metal dishes or pots used for cooking or eating
  • Contamination from living with a person who is exposed on the job
  • Contamination from nearby mining and smelting
  • Cosmetics
  • Cottage industries (e.g., breaking up batteries or metal ore)
  • Drinking water from metal pipes or metal storage containers
  • Food, spices, and candies (from the ingredients or the packaging)
  • Industrial emissions
  • Traditional medicines

Parents or prospective parents

Why this is important

Prospective parents adopting a child from overseas need information to safeguard the health of the child. Concern exists about children adopted from overseas who may have been exposed to lead before they came to the United States. A small number of children recently adopted from overseas have been found to have high levels of lead in their bodies.

Children who have been adopted from other countries can be exposed to lead in different ways.123 They tend to have higher levels of lead in their blood than children born in the U.S.3

How to know if your child was exposed to lead

Most children with lead in their blood do not have any symptoms. The only way to know for sure is to have your child tested with a blood test. Ask your child's doctor to test your child for lead in their blood. You may want to contact your state or local Childhood Lead Poisoning Prevention Program.

Who to contact

Contact your doctor or your local health department if you have concerns about lead in your child's blood.

The American Academy of Pediatrics provides recommendations on comprehensive health evaluations for all children who have been newly adopted.

Intercountry adoption service providers

Adoption service providers play an important role in increasing awareness of lead exposure in children adopted from other countries. Under current regulations and routine practice, blood lead levels among foreign-born children may not be detected.

Adopting parents lack information on the hazards of lead exposure. This information could help them improve their children's growth, development, and prospects for the future.

It is important that adoption service providers provide lead-exposure fact sheets with health information. This includes information on accessible testing sites, to prospective parents. Adoption service providers should also encourage adopting parents and doctors to test foreign-born children for lead exposure when they arrive.

Healthcare providers

International childhood exposure

Children immigrating to the United States through adoptions have health issues as diverse as the cultures into which they were born.45 Research found that a large portion of immigrant children and children adopted from other countries have been exposed to lead. Risk for lead exposure varies by country of origin.123 According to one study, blood levels by region or country were as follows:

  • 40% of children from Cuba and Haiti
  • 37% from Asia
  • 27% from Vietnam and Africa
  • 25% from the Near East

Overall, approximately 11.3% of children who have been adopted from other countries have blood lead levels ≥10 micrograms per deciliter.1

Medical testing

Blood lead testing is not required before immigration to the United States. Before arrival in the United States, all immigrants are required to have a medical examination in their country of origin. These examinations are conducted by a physician approved by the local U.S. embassy or consulate. This medical examination focuses primarily on detecting serious disabilities and contagious diseases.


Children who have been adopted from other countries are considered high risk for lead exposure.456 Screening for blood lead level is recommended upon arrival to the United States and at 12 and 24 months of age. Physicians should follow state and local guidelines when screening of children living in conditions that place them at a high risk. Contact the Childhood Lead Poisoning Prevention Program in your state for additional information.

In 2021, the CDC adopted use of a blood lead reference value (BLRV) of 3.5 μg/dL or higher. This change was based on recommendations from CDC's federal advisory committee made up of experts in the field. Children with blood lead levels at or above the BLRV represent children at the top 2.5%. These children are at the highest blood lead levels. For more information on caring for children with lead exposure, refer to CDC's Recommended Actions Based on Blood Lead Level.


CDC resources

Testing for lead poisoning in children – information on testing children for lead exposure.

CDC's Division of Global Migration Health – CDC division with statutory responsibility to make and enforce regulations necessary to prevent the introduction, transmission, or spread of communicable diseases from foreign countries into the United States.

Intercountry adoption health guidance – information for parents, adoption providers, and clinicians about intercountry adoption.

Recommended actions based on blood lead level – summary of recommendations for follow-up and case management of children based on confirmed blood lead levels.

Refugees and other newcomer persons resettled to the United States – information about lead exposure among children who are immigrants or refugees resettled in the United States.

Video: 'Lead Poisoning Prevention among Children who have been Adopted from Other Countries'

Other federal resources

Child Welfare Information Gateway: Intercountry Adoption – The Child Welfare Information Gateway is a service of the Children's Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.

U.S. Department of State: Intercountry Adoption – This site provides information and guidance to U.S. citizens seeking information about intercountry adoptions.

U.S. Citizenship and Immigration Services – This pdf provides information on intercountry adoptions and the immigration process.

Joint Council on International Children's Services (JCICS) – JCICS is a nonprofit intercountry adoption organization that works to promote ethical practices in intercountry adoption. This site provides information relevant to intercountry adoption service providers, community-based organizations, parent support groups, and medical clinics.

  1. CDC. Elevated blood lead levels among internationally adopted children – United States, 1998. MMWR. 2000;49(5):97-100.
  2. Geltman PL, Brown MJ, Cochran J. Lead poisoning among refugee children resettled in Massachusetts, 1995 to 1999. Pediatrics. 2001;108(1):158-162.
  3. Parisa T, Leighton J, Auchincloss AH, Faciano A, Alper H, Paykin A, et al. Immigration and risk of childhood lead poisoning: findings from a case–control study of New York City children. Am J Public Health. 2008;98(1):92-97
  4. Hellerstedt WL, Madsen NJ, Gunnar MR, Grotevant HD, Lee RM, Johnson DE. The international adoption project: population-based surveillance of Minnesota parents who adopted children internationally. Matern Child Health J. 2008;12(2):162-171.
  5. Jenista JA. The immigrant, refugee, or internationally adopted child. Pediatr Rev. 2001;22(12):419-429.
  6. CDC. Recommendations for blood lead screening of Medicaid-eligible children aged 1–5 years: an updated approach to targeting a group at high risk. MMWR. 2009;58(RR09):1-11.
  • CDC. Childhood Lead Poisoning Prevention Program (https://www.cdc.gov/nceh/lead/).
  • Canfield RL, Henderson CR, Cory-Slechta DA, Cox C, Jusko TA, Lanphear BP. Intellectual impairment in children with blood lead concentrations below 10 µg per deciliter. N Engl J Med. 2003;348:1517–1526.