Substance Abuse : Child Developmental Concerns

by Child Welfare Information Gateway

(Page 7 of 10)

Medical Followup Recommendations

All newborns who have been prenatally exposed to alcohol or other drugs require careful medical followup. The preceding paragraphs have described the array of medical conditions that are not infrequently present in children who were prenatally substance-exposed and that require careful observation. Further, a parent's chemical abuse often can interfere with his/her ability to meet a child's basic needs. Therefore, prior to discharge, it is imperative that members of the health care team, the infant's parent/caregiver, and child welfare professionals actively communicate to clarify the infant's existing medical condition, followup needs, and required level of caregiving. It is the joint responsibility of the health care team and the staff of all involved community agencies [Child Protective Services (CPS) caseworkers, drug treatment counselors, attorneys, judges, and child advocates] to ensure that substance-affected children receive appropriate followup and coordinated care.

Arrangements should be made for the parent/caregiver to visit the hospital before the child's discharge to learn about the infant's special needs and to be instructed in any special caregiving skills.

A home visit by a public health nurse or other appropriate professional before the infant's discharge is important to assess the adequacy and safety of the home environment as well as the family's preparation for the child's arrival. Such visits also can help identify older siblings or other children within the home who are in need of medical care. Post discharge, in-home followup should occur within the first week after discharge, with followup visits scheduled according to family needs. In-home followup should be provided for all caregivers, including parents, relatives, and foster parents.

The infant's parent/caregiver should be provided with a written summary of the infant's diagnoses and medical complications after birth, treatments provided, and needed followup care. This is especially critical for infants who will not be receiving their medical followup with practitioners who are familiar with their historie.

Pediatric well-baby care should be provided more frequently than is customary. An initial appointment should be made with the child's pediatrician within 2 weeks after discharge. Subsequent well-baby appointments should be scheduled at 1, 2, 4, 6, 8, 10, and 12 months. This increased frequency is desirable in order to give parents/caregivers increased support and to provide needed anticipatory guidance. Frequent medical followup also enables better monitoring of a child's ongoing physical care.

Pediatric well-baby care is especially critical for medically fragile infants. In addition to subspecialty followup, such infants also require regular well-baby followup with a primary physician to ensure appropriate immunizations and preventive health care services.

Supportive followup services, including home visits, parenting education, and counseling are essential to maintain and enhance the parent-child relationship.

Often, ancillary supports are also required to ensure that needed followup services are provided. Such supports might include transportation, child care for other children in the family, assistance in coordinating multiple appointments with health care specialists to minimize the number of trips, or even assistance with filling out required forms. This type of coordination requires the collaboration of every member of the service team.

Developmental Concerns

Prenatally drug-exposed infants and young children are at increased risk for developmental problems. Regardless of their health status, all such children need to be evaluated from a developmental standpoint at least once during the first 6 months of life, again at 1 year, and at least every year thereafter until they are school age. Children with recognized developmental problems will need more frequent assessments.

Developmental screening in drug- and alcohol-exposed children is critical because early intervention and early identification of developmental problems are key to optimizing the children's social, language, cognitive, and motor development. As has been demonstrated in other high-risk groups of children (e.g., preterm children, children born small for gestational age, and children with diagnosed physical and/or mental disabilities), infants who experience responsive caregiving environments and young children who are in center-based programs generally show better developmental outcomes than children who do not have these experiences. Through home-, center-, and school-based programs, children affected by parental alcohol and/or other drug abuse can be exposed to enriched environments and given opportunities that will foster their developmental potential.

Developmental Assessment

To evaluate the developmental progress and needs of infants and young children, specialists (e.g., pediatricians, occupational therapists, and psychologists) use standardized tests such as the Bayley Scales of Infant Development, the Gesell Developmental Schedules, and the Denver Developmental Screening Test. These structured measures evaluate the personal/social, language, adaptive/cognitive, and motor skills of the infant and young child. Findings from the evaluation of these four developmental areas provide information about the child's current strengths and problem areas and may help predict later moderate to severe mental retardation. However, these measures are not sensitive enough to identify a specific child who may have a short attention span, learning disability, hyperactivity, or other developmental problems later in life.

Beginning at about 3 years of age, standardized intelligence quotient (IQ) tests such as the Wechsler or the McCarthy scales are used for evaluating a child's cognitive abilities. Measures such as the Achenbach Child Behavior Checklist are useful for assessing social and behavioral problems in older children. Although they may be helpful in providing "warning signs" (e.g., delayed language development, fine motor incoordination, hyperactivity, short attention span) for future learning difficulties, these measures indicate risk status only and cannot be used to predict specific learning problems. Only during the school-aged years can more precise measures be used to detect existing learning disabilities (e.g., attention deficit disorder, dyslexia, etc.).

About the Author

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