Developmental Patterns of Prenatally Drug-Exposed Children

by Child Welfare Information Gateway

(Page 8 of 10)

Infants and young children exposed prenatally to drugs or alcohol display a wide array of developmental patterns that range from normal to deviant. It bears repeating that these patterns are the result of complex interactions among biologic and environmental factors. It is important to keep in mind that children of substance abusers, whether they reside in poor, middle-class, or wealthy households, are at high-risk for environmental deprivation, a critical factor in determining a child's long-term emotional, social, and intellectual development. We can do little to alter biological influences, but we can often mitigate biological risks by promoting healthy environments.

Infancy (0 to 15 Months)

Unpredictable sleeping patterns. Most infants develop predictable sleeping patterns by 4 to 6 months of age. Although newborns generally have short periods of sleep throughout the 24-hour cycle, the typical infant is able to sustain a 6- to 7-hour nighttime sleep sometime between 4 and 6 months of age. Some infants who have been prenatally exposed to drugs or alcohol continue to demonstrate sleeping patterns more typical of a newborn throughout the first year.

Medications have not proven useful in helping these infants organize sleep/wake states.

Respite care is often extremely important in these situations because the infants' erratic sleeping schedules, coupled with their increased irritability, can be exhausting for even the most experienced caregiver.

Feeding difficulties. By the time they are 2 weeks old, most infants have established a somewhat regular pattern of feeding and are able to suck effectively enough to have regained their birth weight. However, infants prenatally exposed to drugs or alcohol may have a variety of feeding difficulties.

Feeding problems commonly reported by caregivers of prenatally drug and alcohol-exposed infants include prolonged feeding time due to uncoordinated and ineffective sucking movements or lethargy, infant distractibility during feeding, frequent spitting up of formula, and increased need to suck (hyperphagia). The following are some suggestions that professionals may find useful in helping parents or other caregivers to deal with these concerns:

• The parent can swaddle and hold the baby during feeding. Propped bottles should not be used.
• The parent should use bottles for feeding liquids only and use spoons for solid foods.
• For a baby who spits up a lot, the parent should burp the infant more frequently (some babies need to be burped after each ounce).
• For an irritable baby, the parent can feed the infant in a quiet place away from other children and distractions and avoid sudden movements.
• For an unusually sleepy baby, the parent should allow more time for feeding and provide extra encouragement to keep the baby awake such as massaging the back or rubbing the soles of the feet while talking softly.
• For a baby who has an intense need to suck even after the infant's stomach is full, the parent can offer a pacifier to avoid overfeeding.

Irritability. A range of temperaments is seen in all neonates. Some infants tend to be easygoing and are readily soothed when fussy, but others tend to be more irritable and are harder to calm. Caring for these infants is more difficult. Infants who have been prenatally exposed to drugs and alcohol often display such irritability. They can be easily overstimulated and, once aroused, have great difficulty calming themselves. For such infants, professionals can offer the following recommendations to parents/caregivers:

• Swaddle the baby, with hands exposed.
• Walk and hold the baby close to the body, using a front carrier (the combination of swaddling, body contact, and gentle motion puts many fussy babies to sleep).
• Bathe the baby in warm water, followed by a gentle massage.
• Place the infant face down on the parent's/caregiver's abdomen and gently massage his/her back.
• Offer a pacifier.
• Speak softly.
• Gently rock the baby in a windup cradle or swing, ensuring that his/her head is well supported.
• Play soft music in a quiet room, and avoid bright lights, jostling, and loud noises.
• Support the baby's bottom with one hand and his/her head with other hand, hold the baby away from the parent's/caregiver's body in an upright position, and rock the baby gently in an "up and down" motion.

Atypical Social Interactions. Social interactions begin at birth. When awake, the newborn infant will respond by turning toward a voice and will visually connect and look at the caregiver. These are brief behaviors, but they are especially rewarding to parents as they begin the attachment process. By 4 months of age, the typical infant is cooing in response to social exchanges, makes direct eye contact, and has a social smile for persons in the immediate environment. At 6 months of age, this highly social child becomes more discriminating and smiles less at strangers.

Infants who have been prenatally exposed to drugs and/or alcohol may have a number of atypical social responses, including indirect gaze, gaze aversion, and less marked stranger discrimination during the second half of the first year. Professionals should:

Provide explanations to help parents/caregivers to keep from personalizing the infants' interactive behaviors.

Remind parents/caregivers that the children's social responses and interactions will improve if they are given appropriate time and opportunities. When gaze aversion occurs, it may indicate a need for decreased stimulation.

Encourage consistency of parents/caregivers to support the children's early attachment needs.

Delayed language development. Language development during early infancy involves cooing, smiling, chuckling, squealing, and crying. Infants who have had prenatal exposure to drugs and alcohol may demonstrate fewer vocalizations and less babbling. Language development can be promoted if professionals encourage parents/caregivers to:

Talk with the infant during bathing, feeding, and changing times.

Respond to the infant's attempts to vocalize, reinforcing responses with eye contact and animated facial expressions.

Increased muscle tone and poor fine motor development. Motor development follows a similar pattern in all healthy infants. However, there is some variation in the age at which individual milestones are normally achieved. Young infants exposed prenatally to heroin and methadone generally reach gross motor milestones at appropriate ages. However, these infants frequently exhibit increased muscle tone (stiffness). In contrast, young infants exposed to stimulants such as cocaine may have decreased muscle tone and variable motor development, though most demonstrate attainment of milestones at an appropriate age. Furthermore, among older infants who were prenatally substance-exposed, there may be problems with fine motor coordination, unsteadiness in the movement of extremities, and mild problems with balance. For such babies, professionals should recommend that parents/caregivers:

Encourage activities that provide safe opportunities for rolling over, crawling, and pulling to a standing position.

Provide opportunities to practice reaching for and grasping small, lightweight toys. Encourage feeding with finger foods, such as cereal or crackers.

About the Author

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