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Wednesday, August 17, 2022

Indiana lowers threshold for blood lead levels for children

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The Indiana Department of Health adopted an emergency rule that lowers the threshold for diagnosing lead poisoning in children. The ruling, which went into effect July 1, lowers the blood lead level from 10 micrograms per deciliter to 3.5 mcg/dL, allowing more children to receive case management from the state.  

This matches the Centers for Disease Control and Prevention’s standards, said Cassidy Clause, an Indiana University McKinney School of Law student who focuses on lead. 

“Overall, it’s a wonderful thing that is happening and it’s much overdue,” Clause said. 

Under the new guidelines, children with blood lead levels between 3.5 and 4.9 mcg/dL and their families will receive education about risks and be advised to test siblings. Children with a confirmed level of 5 or above will be enrolled in case management and be encouraged to allow health department staff to do a home risk assessment, which includes discussing potentially leaded objects and surfaces and identify educational, nutritional and developmental support services that may be available to the child. The home assessment will also test surfaces to determine where lead hazards may exist and help the family determine how to best address those.  

“We’re gonna have so many more children who are receiving help that they desperately need because there is absolutely no safe level of lead,” Clause said. “Assuming this rule goes through, which is the hope, I think it’s going to be a great thing for getting these services to many, many more kids who need it.” 

The new threshold follows House Enrolled Act 1313, which takes effect Jan. 1, 2023, that requires health care providers to offer universal lead screenings for children under 6. Previously, only children covered by Medicaid were required to be tested at 12 and 24 months, according to a press release from the Indiana Department of Health. The health department adopted the emergency ruling so children and their families can get the care they need right away.  

What prompted the change was a petition signed by over 40 concerned experts, including United States Secretary of Transportation Pete Buttigieg, Marion County Public Health Department Director Dr. Virginia Caine and Hoosier Environmental Council Director Indra Frank. 

“This is really good news,” Frank said. “A child who’s gotten lead into their system is more likely to struggle in school. They’re more likely to have behavior problems; that child is being held back from his or her full potential. When we’ve got that many kids being hampered like that, that’s holding our state back from reaching our full potential.” 

The state sees roughly 200 children diagnosed with elevated lead levels each year, but that number could reach about 2,000 with the new standard. 

Despite the increased caseloads on both local and state health departments, helping children get the management they need, and prevent future children from increased blood lead levels, will be worth it in the long run, Frank said. 

In 2020, more than 12,000 children were tested for lead and only 28 were confirmed to have elevated blood lead levels in Marion County. Of those, 279 children had at least one test result between 5 and 9.9 mcg/dL, according to CDC data.  

The most common source of lead exposure in Indiana is housing, according to Frank. Marion County has increased lead levels in many areas, disproportionately affecting Black and brown residents the most, according to research from IUPUI. The Indiana Advisory Committee wrote its 2020 report to the U.S. Commission on Civil Rights entirely on lead poisoning, stating: “Indiana has a troubling history with caring for and protecting non-white residents from lead poisoning.” Nearly 60% of Marion County’s housing was built before 1978, when lead was still being used in paint, Clouse said in a previous interview with the Recorder. 

Lead exposure can damage the brain and nervous system, leading to behavior problems, problems with impulsivity, cause nausea and hearing loss and have other debilitating effects. 

“Every Indiana child deserves to be protected from the hazards of lead exposure,” State Health Commissioner Kristina Box said in a press release. “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.” 

Contact staff writer Jayden Kennett at 317-762-7847 or by email jaydenk@indyrecorder.com. Follow her on twitter @JournoJay. 

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