The Indiana Department of Health (IDOH) has adopted an emergency rule that lowers the level at which it determines a child has elevated blood lead levels. The move, the initial step toward a permanent change, is part of continued statewide efforts to increase lead testing and reduce the risk of lead exposure, which can lead to lifelong health effects in children.
Effective today, Indiana’s blood lead reference value stands at 3.5 micrograms per deciliter, in alignment with values set by the Centers for Disease Control and Prevention (CDC). This level is used to identify children with blood lead levels that are higher than those of most children under age 6.
“Reducing the blood lead threshold in Indiana has been a years-long process that has required partnerships with healthcare providers, local health departments and lawmakers to identify the resources and funding needed to ensure that more Indiana children not only were tested for lead, but that those with elevated levels could receive appropriate services,” said State Health Commissioner Kris Box, M.D., FACOG. “The CDC states clearly that no level of lead is safe in a child, and we are grateful to state lawmakers for providing funding through House Enrolled Act 1007 to support our efforts to increase testing and case management to protect our most vulnerable Hoosiers.”
Under the new guidance, families of children who have a blood lead level between 3.5 and 4.9 micrograms per deciliter will receive education about lead risks and be advised to test siblings in the same household. Children with a confirmed level of 5 or above will be enrolled in case management, in which families are offered a home visit by trained case support personnel and a home risk assessment by a licensed assessor. Families are encouraged to participate in the home visit, in which staff from the local health department will talk about the child’s environment, discuss what potentially leaded objects or surfaces they may be around and identify support services (nutritional, developmental, educational) that may be available to the child. The home assessment will test surfaces inside and outside of the home to determine where lead hazards may exist and help the family determine how to best address those.
The lower thresholds are expected to increase lead caseloads across the state from roughly 600 children per year to nearly 2,000 in the first year of the program.
The new thresholds follow legislation signed into law earlier this year that requires healthcare providers to offer universal screening for lead for all children under age 6. Previously, only Indiana children covered by Medicaid were required to be tested for lead at 12 and 24 months. House Enrolled Act 1313 takes effect Jan. 1, 2023.
Lead exposure can damage the brain and nervous system, lead to learning and behavior problems, slow growth and development, cause nausea and hearing loss and have other debilitating effects. Young children are especially vulnerable because their bodies are still developing and growing rapidly. Although plastics, toys, jewelry and other consumer products can be sources of lead, the primary source in Indiana is lead-based paint and lead dust from painted surfaces in homes built before 1978.
“Every Indiana child deserves to be protected from the hazards of lead exposure,” Dr. Box said. “Unfortunately, before this funding became available, some counties were able to offer case management to children whose lead levels were between 5 and 9.9 micrograms per deciliter, and others were not. These changes help ensure that every child has access to the same level of case management and puts Indiana among the states leading the nation by providing case management services at a level of 5.0 or higher.”