Children of Chemically Involved Parents: Special Risks

by Child Welfare Information Gateway

CASE VIGNETTE: Although born full term, Lisa's baby boy, Timmy, remained in the hospital for over a week following birth because of his small size and feeding difficulties. He also was very irritable, difficult to soothe, and slept only for brief periods of time. At 5 months of age, Timmy continued to demonstrate bizarre fisting and stiffness of his hands. Because of ineffectual sucking, each feeding took over 45 minutes. Timmy was also easily upset but enjoyed being held. By 1 year of age, the stiffness and irritability had resolved, and Timmy's weight gain and development appeared to be well within the normal range. However, he continued to have difficulty sleeping through the night, and this was very stressful for his caregiver. Eventually it became clear that this little boy's cognitive and language behaviors were average, and by age 4 Timmy's preschool teacher reported that he was well-behaved, although concerns remained regarding his short attention span and the difficult time he had sitting still and following directions. During his first 2 years in elementary school, Timmy's short attention span interfered with his ability to concentrate, and he needed extra help from a research teacher to keep up with reading and arithmetic skills. School staff continue to watch Timmy for potential learning difficulties related to short attention span and hyperactivity.

This chapter describes the health and development of children exposed prenatally to alcohol and/or other drugs. The neurodevelopmental consequences of such exposure, particularly in the long term, are not all known. Research is currently being conducted to help us better understand these consequences. In discussing the common health concerns and developmental patterns that have been observed in this population, it is important for professionals to consider the following issues:

Polysubstance abuse. Most substance abusers use multiple drugs or drugs, alcohol, and nicotine in combination. In some cases, this polysubstance abuse may occur without the user's knowledge because it is common practice among street dealers to substitute drugs and to "cut" the purity of illicit substances with a variety of adulterants. Furthermore, although parents may report use of only alcohol, nicotine, or a single drug, such statements regarding drug and alcohol use during pregnancy are often unreliable, in part because of parental inaccuracy in recalling their actual drinking or drug use during periods of intoxication.

Range of outcomes. Any alcohol or other drug use during pregnancy potentially can affect fetal health and well-being. There are no known "safe" levels of prenatal drug, alcohol, or nicotine use. However, among infants who have been prenatally exposed to these substances, a wide range of health and developmental patterns have been observed. The medical and developmental complications associated with prenatal substance abuse will be discussed later in this chapter. Because there is a broad continuum of effects of prenatal drug, alcohol, or nicotine exposure (varying from severe to mild to no apparent effect), outcomes for individual children cannot be predicted.

Multiple etiologies. There clearly are adverse immediate and long-term effects of alcohol and other abuse during pregnancy, but there are also a number of other maternal health, nutritional, and lifestyle factors that greatly impact fetal growth and development. These factors also significantly contribute to the increased risk of developmental difficulties throughout childhood. Substance-abusing mothers often have compromised health, no matter what their socioeconomic status. Smoking, poor nutrition due to excessive dieting or inappropriate selection of food, poverty, or other lifestyle influences may complicate the effects of substances on the fetus.

Environmental impact. Children in substance-abusing families are at double jeopardy-they are both biologically and environmentally at risk. Moreover, the interplay between biological and environmental factors is extremely significant because biological problems can be exacerbated or mitigated by environmental influences. For example, a home environment that is responsive and nurturing can help reduce the negative developmental effects of low birth weight. On the other hand, an environment that does not provide adequate nurturing can increase the risk of negative developmental outcomes associated with low birth weight.

Limitations of research. Obtaining accurate self-reports about alcohol or other use is difficult and limits epidemiological and clinical research on causality. Most documentation about the serious side effects of prenatal alcohol and other drug exposure in infants and children has been noted in cases of alcoholic and drug-dependent mothers. Little is known regarding the effects of experimental or sporadic drug and alcohol use during pregnancy, in part because the identification of occasional users is much more difficult. Even less is known about the effects of paternal substance abuse. Furthermore, the standardized measures currently used to evaluate infants and young children of chemically involved parents are not sufficiently sensitive to subtle behavioral and cognitive deficits.

Keeping in mind the above issues and the fact that many important questions regarding the effects of maternal drug and alcohol abuse remain unanswered, the following sections will discuss the common neonatal and infant complications that have been described in some substance-exposed infants and young children as well as the developmental patterns that have been observed in this high-risk population. It is important to note that the descriptions contained in this chapter are intended to provide general information and followup guidelines. Concerns about individual children need to be discussed with the child's pediatrician, a child psychiatrist, other health care providers, family members, and any other professionals who are involved in providing care.

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