Healthy Kids Minnesota: 
Information for Health Care Providers

As a health care provider, you may be hearing from families of patients who participated in Healthy Kids Minnesota, a program by the Minnesota Department of Health to measure environmental chemicals of concern in the urine of preschool-aged kids across the state. We are partnering with school districts and local public health agencies to recruit three- to six-year-old children with parental consent and collect a urine sample during their Early Childhood Screening appointments. 

How are health care providers involved?

Health care providers are not involved in recruiting children, collecting urine samples, or communicating results with families. However, we know that some families may bring their child’s results to their health care provider with questions.

What chemicals are being measured?

The Public Health Laboratory at MDH measures more than 60 chemicals in children’s single spot urine samples, including metals, pesticides, environmental phenols, phthalates, flame retardants, and air pollution markers. More information about these chemicals and ways families can reduce exposures in children can be found at Healthy Kids Minnesota: Chemical Information and Resources.

How do families receive their child’s results? 

Test results are returned to families in two steps.

1. Phone follow-up response for arsenic, manganese, and mercury.
   1. For three chemicals – urine arsenic, manganese, and mercury – MDH has set follow-up levels that indicate a higher-than-expected urine result. Exceeding our follow-up levels for these three chemicals does not mean that a child’s health with necessarily be affected. It means it is possible the child has an elevated exposure to the chemical, and it is important to follow-up on the results to see if we can work with the family to find and reduce the exposure.
   2. If a child’s result exceeds a follow-up level, the MDH laboratory reports results more quickly and MDH staff (usually a contracted family physician) contacts the family to share the result and answer their questions. We also ask the family follow-up questions about ways the child may have been exposed and discuss possible exposure sources with them, and whether they would like us to share the results and information with their child’s health care provider. 
   3. In some cases, we can offer the family an intervention to reduce the exposure. For example, if drinking from a private well may be a source of the child’s higher-than-expected arsenic or manganese result, we can offer free private well testing and treatment information. Or, if home use of a skin lightening product that may contain mercury may be a source of the child’s higher-than-expected mercury result, we can offer a free home visit to check for mercury contamination. 
   4. If a change is made based on the intervention or the family is very concerned, we can offer a free urine re-test by the MDH Laboratory. Because all of these chemicals have short half-lives in the body, a urine re-test can indicate whether efforts made to reduce exposures in the child are working or can be a good check of the original result.
2. Mailing of results for all remaining chemicals.
   1. For the remainder of the chemicals (60+ chemicals in six different categories – see above), families will receive their child’s results in three separate mailings. The results packets include a cover letter, a results table with the child’s results compared to other children in the program, and information sheets that provide background on the chemicals being tested and share advice for families on ways to reduce child exposures. 
   2. In addition, soon after this mailing, MDH staff will call families whose children have notably high results to answer any questions families may have.

What do levels measured in urine mean for a child’s health? 

The chemicals included in Healthy Kids Minnesota may impair child development or be linked with other health outcomes in children. However, scientists are still learning about what chemical levels in kids’ urine are safe. Unlike with lead, for instance, there are no clear and accepted medical cutoff points for health concern in children. 

Families involved can learn about exposures their child is having, and whether these exposures seem to be higher or lower than average. They also learn about ways to reduce exposure to the different types of chemicals.

Results will help inform families and address community concerns and help promote policies and programs to reduce childhood exposures. More broadly, Healthy Kids Minnesota will:

• Provide MDH with a picture of children’s environmental exposures in Minnesota
• Tell us more about ways in which Minnesota children are exposed to these chemicals, and 
• identify whether some groups of children are more vulnerable to exposures than others. 

How can I help advise or support my patients?

There is no expectation to ‘treat’ these results – if a child was above our follow-up threshold for arsenic, manganese, or mercury, or on the very high end of exposure for other chemicals, they would have received a follow-up phone call from MDH. You can emphasize that the results do not mean that a child’s health will be affected – most people tested have levels of these chemicals in their bodies. Being part of this program is helping MDH to learn more about chemical exposures in kids in Minnesota. And we are providing families and communities information and ideas for reducing childhood exposures. If the family has very specific questions about the chemicals that you are unable to answer, feel free to give them MDH contact information below.

The family’s conversation with you is also an opportunity to emphasize the importance of regular well care and developmental testing.

What is a good contact for more information?

Contact us by email or phone if you have any further questions. We can also join lunch-and-learns or other regular provider meetings to share more information about the program, ways to talk with families, and our findings. Please contact Jessica Nelson, Jessica.Nelson@state.mn.us, 651-201-3610 with any questions.