Introduction
Prenatal and infant exposure to drugs or alcohol continues to be a growing concern for those entrusted with protecting the interests of children, as well as society at large. Substance abuse by parents and caregivers has had a devastating effect on families, especially the children who have been the innocent victims of exposure to drugs. The number of children born each year exposed to drugs and/or alcohol in our nation is estimated to be between 550,000 and 750,000. It is widely accepted that drug use during pregnancy may result in adverse effects on the health and well-being of the newborn, in addition to the health of the mother.
There is growing concern for the care and safety of substance-exposed newborns in Arizona. Early intervention services for both the newborn and the mother are critical in minimizing the effects of prenatal substance exposure.
Based on extensive medical literature review, review of other state guidelines, and input from hospital newborn programs, this committee drafted Guidelines for Identifying Substance-Exposed Newborns.
The Relationship Between Substance Abuse and Child Abuse
In addition to the biological risk that prenatal alcohol or drug exposure poses to these children, they are at an increased risk of child abuse and neglect by parents whose need for drugs takes priority over the care of their infants and children. As a result of these factors, there has been a sharp increase in the number of drug exposed children in out-of-home placements.
The driving force behind new efforts to identify and protect substance exposed infants and children is the understanding that intervention services for the newborn and mother are critical in minimizing the acute and long-term effects of prenatal substance exposure. Even if a newborn exhibits no clinically significant difficulties in the neonatal period, identification of a substance-exposed newborn may improve the infant?s long-term development.
There is also increasing concern about the negative impact on children when parents or other members of the household engage in other illegal drug-related activity, such as the manufacture of methamphetamines in home-based laboratories. The state of Arizona has responded to the growing problem of the manufacturing and distributing illegal substances by parents and caregivers by expanding the civil definition of child abuse or neglect so that children living in dangerous home environments can be protected.
The Ways in Which Children Are Exposed
Substance exposed infants are not only classified as such due to prenatal exposure to drugs and alcohol. Approximately 50% to 80% of all child abuse and neglect cases substantiated by Child Protective Services involve some degree of substance abuse by the child?s parents.1 This can be due to a variety of factors including:
- The often chaotic lifestyles and social instability where the primary focus of a parent or caregiver is directed towards obtaining and using drugs, instead of attending to the basic needs of an infant.
- Substance abusing parents lose touch with reality, making them emotionally unavailable to their infants for much of the time.
- Substance abusing parents are repeatedly observed having trouble balancing the needs of their infants with their drug use.
The Effects of Exposure
Low Birth Weight
Birth weight is an important factor associated with children?s overall health and development. Children who weigh under five-and-one-half pounds at birth are more likely to have serious medical problems and to exhibit developmental delays. Drug-exposed infants often do not exhibit normal development.
Premature Birth
The risk of premature birth (birth at less than thirty-seven weeks) is higher in drug-exposed infants. Other complications can include an increase in acute medical problems following birth, and extended periods of hospitalization. Birth weight under three pounds has been associated with poor physical growth and poor general health status at school age.
Failure to Thrive (FTT)
Infants who were exposed to alcohol and/or drugs may exhibit this disorder, which is characterized by a loss of weight, or slowing of weight gain, and a failure to reach developmental milestones.
Neurobehavioral symptoms
Within seventy-two hours after birth, many infants who were exposed prenatally to drugs experience withdrawal symptoms, including tremors and irritability. Their skin may be red and dry; they may have a fever, sweating, diarrhea, excessive vomiting, and even seizures. Such infants may require medication for calming. Other infants exposed to stimulants show a pattern of lethargy during the first few days after birth, are easily over stimulated, and may go from sleep to loud crying within seconds.
Infectious diseases
Infants with prenatal drug exposure may be exposed prenatally or postnatally to infectious and/or sexually transmitted diseases contracted by their mothers. The most common infectious diseases seen in infants are Chlamydia, syphilis, gonorrhea, hepatitis B, HIV, and AIDS.
Neglect of Basic Necessities
Child neglect is characterized by failure to provide for the child's basic needs. Neglect can be physical (for example, inadequate clothing for cold weather), medical (for example, refusal to seek health care when a child clearly needs medical attention), educational (for example, failure to enroll a child of mandatory school age), or emotional (for example, chronic or extreme spouse abuse in the child's presence). Severe neglect often results in death, particularly in the case of very young children. While physical abuse tends to be episodic, neglect tends to be chronic. Neglectful families often appear to have many problems that they are not able to handle. It is often very difficult to facilitate change in the behavior of chronically neglectful families. For early childhood caregivers, neglect may also be chronic. For example, it might be standard practice for a caregiver to leave infants in their cribs for most of the day, rather than providing a safe area for them to move about.
Children of substance abusers often find themselves denied basic needs such as food, hygiene, shelter, and protection from the abuse and neglect perpetrated on them by others who frequent homes of drug abusers.
Exposure to Unnecessary Risk
Exposure to the world of substance abuse often brings exposure to unnecessary risks and dangers for the small children who are unable to protect themselves from harm. A neglected child is one whose physical or mental health or welfare is harmed or threatened with harm by the acts or omissions of his/her parent or other person responsible for his/her welfare.
Reports of child abuse and neglect have increased significantly over the past decade, correlating with an increase in drug use among primary caregivers. The chart below illustrates the prevalence of neglect in regards to child abuse.
1 U.S. Department of Health and Human Services. National Center on Child Abuse and Neglect. Protecting Children in Substance Abusing Families. 1994
Chasnoff, I.J. (1989). Drug use in women: Establishing a standard of care. Annals of the New York Academy of Science, 562, 208-210.
Gomby, D., and Shiono, P. (1991). Estimating the number of substance-exposed infants. The Future of Children: Adoption, 1 (1), 17.
Schipper, W. (1991). Testimony before the U.S. House of Representatives Select Committee on Narcotics Abuse and Control.
