Indiana widens child lead threshold, raises family support

The Indiana Department of Health on Friday adopted an emergency rule expanding what it considers “elevated” lead levels in a child’s blood, and introduced family education and case management for children with the neurotoxin in their blood. 

“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 in a news release.

The department called it the “initial step toward a permanent change” in the release.

Box’ department and the U.S. Centers for Disease Control and Prevention hold that there’s no safe level of lead for children. But since 2012, when the CDC lowered its definition of “elevated” levels to 5 micrograms per deciliter, Indiana’s definition remained double that used in federal guidance.

And in October 2021, the CDC lowered its threshold again to 3.5 micrograms per deciliter. Indiana’s lining up with that number, effective July 1.

More help

Indiana’s new health guidance comes with increased support for families with children identified as having high blood levels.

The health department said it would provide families of children with levels between 3.5 and 4.9 micrograms with education about lead risks, and would tell those families to test siblings living in the same household. The department said it would offer case management in the cases involved children with levels above 5 micrograms, which includes a home visit by case support personnel and a home risk assessment by a licensed assessor.

“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,” Box said. “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.”

Box’s department said it expected the lower thresholds to grow Indiana’s lead caseloads from 600 children annually to nearly 2,000.

Indiana’s soon taking more action on child lead exposure. When House Enrolled Act 1313 goes into effect in January, it will require health care providers to offer universal lead screening to all children under 6 years old. Until then, only children covered by Medicaid were tested, at 12 and 24 months.

Lead exposure damages the brain and nervous system. Children are especially vulnerable to its effects. Most lead exposure in Indiana is through lead-based paint and dust in pre-1978 homes, according to the health department.