Improving Systems, Practices, and Outcomes

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Young Children Exposed Prenatally to Substances and Their Families

This page developed in partnership with the IDEA Infant and Toddler Coordinators Association (ITCA).

Introduction

Two broad types of prenatal substances are most prevalent: prenatal exposure to alcohol, including the diagnosis of Fetal Alcohol Spectrum Disorders and prenatally affected by illegal substance abuse or having withdrawal symptoms resulting from prenatal drug exposure including the diagnoses of Neonatal Abstinence Syndrome, opioid exposure, to name a few.

Research conducted by the Center for Disease Control (CDC) in 2015 indicates that 1 out of 10 pregnant women aged 18–44 reported using alcohol and 1 out of 33 pregnant women reported binge drinking within the last 30 days.

CDC research indicates that the national rate for opioid use disorder has more than quadrupled between 1999-2014. The research acknowledged that the prevalence rate is likely underreported based on several factors.

With rising rates of substance use disorder in women of child-bearing age, state and local early intervention systems seek knowledge regarding identifying the prevalence of infants and toddlers prenatally exposed to substances, and the resources and supports needed to promote positive outcomes for these infants and their families. ECTA Center and ITCA have partnered to provide key research, policy, guidance and state examples, and evidence-based practices for supporting young children exposed prenatally to substances and their families.


Federal Laws and Guidance

See also: Referral Requirements under CAPTA and Part C

The Child Welfare Gateway Information, Children's Bureau, Department of Health and Human Services has a searchable database of state laws related to child abuse and neglect that includes state definitions related to illegal substance use and required reporting to child protective services.

Definitions of Child Abuse and Neglect: State Statutes (2016) provides a brief descriptive overview.


Research

American Academy of Pediatrics (AAP)


Center for Disease Control

Fetal Alcohol Spectrum Disorders (FASD) is the term that describes a range of effects that can occur in young children who are exposed to alcohol during the prenatal period. Effects may include physical, behavioral, and/or learning or developmental disabilities. Terms that are used diagnose young children with the FASD are:

  • Fetal Alcohol Syndrome (FAS)
  • Partial Fetal Alcohol Syndrome (PFAS)
  • Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE)
  • Alcohol-Related Neurodevelopmental Disorder (ARND)

CDC studies have estimated rates of FAS, 0.2 to 1.5 infants for every 1,000 live births in certain areas of the United States. Analysis of medical and other records indicate that FAS identified 0.2 to 1.5 infants with FAS for every 1,000 live births in certain areas of the United States. Other studies using in-person assessments of children in the first grade indicate higher estimates: 6 to 9 out of 1,000 children.

Research and fact sheets from CDC include:

Morbidity and Mortality Weekly Reports (MMWR) provides timely and accurate scientific information on a broad range of public health information and recommendations. See the following MMWR for information related to this topic:

CDC and the American Academy of Pediatrics have also published the following papers that may be of interest:


Other Research Sources


Policy and Guidance

The Children's Bureau

Responding to Infants Affected by Substance Exposure

States are required by the CAPTA legislation to have policies and procedures for reporting substance-exposed newborns to child protective services, to assess the need for intervention, and establish a plan of care. Strategies used in the States to address prenatal substance exposure, information about the various effects of the most common drugs involved with prenatal exposure are highlighted.


Child Maltreatment 2018 (2020)

This annual report presents national data about child abuse and neglect reported to child protective services agencies in the United States. Chapter 7 focuses on infants with prenatal substance exposure (IPSE) (see pages 88–91 and Tables 7-5 through 7-9 on pages 97-101).

CAPTA requests a count of infants with prenatal substance exposure. To be included in the count, a child must meet the following conditions as defined by NCANDS data elements:

  1. The child must be in the age range of birth to 1 year old.
  2. Referred to CPS by a health care provider.
  3. Born with and identified as being affected by substance abuse or withdrawal symptoms. The child must have the alcohol abuse, drug abuse, or both alcohol and drug abuse child risk factors.

The legislation does not require the infants to be considered victims of maltreatment solely based on the substance exposure, and drug abuse includes legal and illegal drugs (including alcohol exposure).


Maternal and Child Health Bureau

HRSA'S Home Visiting Program: Supporting Families Impacted by Opioid Use and Neonatal Abstinence Syndrome (2018)

This document provides essential information about the opioid epidemic, opioid use disorder (OUD), and neonatal abstinence syndrome (NAS) including: relevant research; strategies for MIECHV awardees and their state partners (e.g. early childhood, public health, and substance misuse and mental health treatment) and promising efforts four states, Maine, Colorado, West Virginia, and Massachusetts.


National Academy of State Health Policy (NASHP)

The National Academy of State Health Policy (NASHP) is a nonpartisan forum for policymakers in states to improve challenges in health policy.


Office of Head Start

Head Start and the Early Childhood Learning and Knowledge Center have developed a number of resources and to address children and families affected by prenatal substance exposure.

Head Start Takes a Stand Against Opiods (2019)

Find out how the Office of Head Start (OHS) is addressing the opioid crisis and other substance use disorders. In this video, Dr. Bergeron shares some of the creative approaches Head Start programs have taken to support children who are affected by substance use, including wrap-around care and supports to grandparents who are raising their grandchildren. She also discusses the regional meetings on opioids and highlights the relationships established with the medical community. Dr. Bergeron shares a love note about an organization in Missouri that created a pioneering bridge program to continue providing family supports to Head Start children from kindergarten to second grade.


Substance Misuse During Pregnancy

This topical page includes talking points and fact sheets to support home visitors as they work with families who may experience substance misuse.


Office of Special Education Programs

Topical Issue Brief: Intervention IDEAs for Infants, Toddlers, Children, and Youth Impacted by Fetal Alcohol Spectrum Disorders (FASDs) (2017)

This document outlines the different FASDs, discusses prevention, and provides behavioral and academic interventions for families, infants and preschool-aged children.


Topical Issue Brief: Intervention IDEAs for Infants, Toddlers, Children, and Youth Impacted by Opioids (2016)

This document provides an overview of research, risk factors, potential symptoms in young children and school-aged children, and provides evidence based resources for each age group.


Substance Abuse and Mental Health Services Administration (SAMHSA)

The National Center on Substance Abuse and Child Welfare (NCSACW) is jointly funded by SAMHSA and the Children's Bureau. Some resources of interest include:

Fetal Alcohol Spectrum Disorders Center for Excellence

This center hosts a large collection of resources on fetal alcohol spectrum disorders (FASD).


Partnering to Support Families Affected by Opioid and Other Substance Use Disorders


Project Launch

This project focuses on children birth to 8, to promote children entering school with the skills they need, social, emotional, cognitive and physical skills, collaboration among child-serving organizations, and integrate physical and behavioral health services and supports. Their website includes a page on opioid use.


National Institute for Children's Health Quality

National Institute for Children's Health Quality (NICHQ) is a nonprofit that focuses on improving children's health outcomes through partnerships that build sustainability.

NICHQ provides support for the National Network of Perinatal Quality Collaboratives, funded by Centers for Disease Control and provides resources on the effects of the opioid epidemic on maternal health.

Perinatal Quality Collaboratives (PQCs), with joint funding from CDC and March of Dimes, are state or multi-state networks of multidisciplinary teams, working to improve outcomes for maternal and infant health. PQCs do that by advancing evidence-informed clinical practices and processes using quality improvement (QI) principles to address gaps in care. PCQs work with clinical teams, experts and stakeholders, including patients and families, to spread best practices, reduce variation and optimize resources to improve perinatal care and outcomes. The goal of PQCs is to achieve improvements in population-level outcomes in maternal and infant health. PQCs current areas of focus are:

  • Reduce preterm births
  • Reduce severe pregnancy complications associated with high blood pressure and hemorrhage
  • Improve identification of and care for infants with neonatal abstinence syndrome
  • Reduce racial/ethnic and geographic disparities
  • Reduce cesarean births among low-risk pregnant women

State Examples

Substance Exposed Newborns and Part C: New Challenges and New Opportunities

This conference session from the 2018 Improving Data Improving Outcomes Conference features examples from Indiana, Massachusetts, and West Virginia.

The use of opioids in the general population has reached epidemic proportions. There have been many media reports related to infants prenatally exposed to opioids as well as other legal and illicit substances. States struggle with the resources and supports that are needed to promote positive outcomes for infants. Coordinators from three states at the epicenter of the opioid crisis will discuss the challenges they have encountered in addressing this population.


Illinois Department of Human Services

Prenatal Opiate Exposure: Impact on Early Childhood Learning and Behavior (2018)

This Bureau of Early Intervention webinar is presented by Dr. Ira Chasnoff):


Pennsylvania Bureau of Early Intervention Services, Office of Child Development and Early Learning, Department of Education and Department of Human Services

Keep Kids Safe: Plans of Safe Care presents resources related to plans of safe care for infants who are affected by prenatal substance exposure. It includes:

Plans of Safe Care Webinar


Texas' Office for Disability Prevention for Children

FASD-related flyer that includes information on how to make a referral to the Early Intervention program. Links to both the English and Spanish flyers below: