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Improving Systems, Practices, and Outcomes

Young Children Exposed Prenatally to Substances and Their Families

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

On This Page

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

This CDC page includes information includes facts, research and resources for professionals:

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

Center for Disease Control

This CDC topical webpage provides an overview to Fetal Alcohol Spectrum Disorders, including treatment and early intervention services.

The Children's Bureau

Plans of Safe Care for Infants With Prenatal Substance Exposure and Their Families

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. This publication includes a link to the state statutes, and describes the components of a plan of safe care including notification and reporting requirements, assessments of the infant and family, services for the infant and family and monitoring of the plan.

Child Maltreatment

This annual report from the Children's Bureau presents national data about child abuse and neglect reported to child protective services agencies in the U.S.

Harm Reduction in the Context of Child Well-Being

This series provides an overview of a harm reduction approach that meets the needs of children, parents, and family members affected by substance use disorders. This 3-part tip series highlights policy and practice considerations to improve recovery, safety, and well-being outcomes.

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 on Substance Use Disorder and Recovery, including the following:

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).

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: