Learning About Prenatal Drug Exposure

Our adoption medicine expert explains the symptoms — short- and long-term — of prenatal drug exposure, and what adoptive parents can do to help kids recover.

A mother discusses prenatal drug exposure with her child's doctor

The possibility of prenatal drug exposure is a concern for many prospective adoptive parents, who may not always receive accurate or complete information about the birth mother’s past drug use. From the time of birth, exposed children experience symptoms of drug withdrawal that can be vague — some infants show few or no symptoms — and in most cases, the child is not dealing with the effects of a single drug. This range of symptoms, known as Neonatal Abstinence Syndrome, can affect any infant whose mother is/was addicted to opiates, including heroin and methadone. There are multiple factors — timing, dosage, substance(s) used — that determine how a child might be affected over time. Fortunately, many children who are exposed to drugs in utero go on to lead normal, healthy lives. While you can’t change your new baby’s genetics or early environment, you can give her a safe, nurturing environment from the moment you bring her home. Recognizing symptoms early on can help you protect your child’s health, in infancy and in the long term.

Symptoms that Indicate Prenatal Drug Exposure

Many symptoms of withdrawal, like difficulty sleeping or eating, resistance to cuddling and soothing, and irritability, are not severe, decrease over time, and can be managed and/or treated. Symptoms typically appear 48 to 72 hours after birth, but in some instances may not appear for one to two weeks. Infants may experience tremors of arms and legs, seizures, tight muscle tone, and hyperactive reflexes. Other signs of withdrawal include excessive crying or yawning, congestion and sneezing, vomiting, diarrhea, dehydration, and fever. Sleep problems may persist for four to six months, and feeding problems through the first year or longer. Not every child is affected in the same way, but many symptoms will decrease over time, typically by toddler age.

Long-Term Outcomes

Exposure to heroin, methadone, and other opiate drugs usually does not have a long-term effect on IQ. Instead, exposed children may be more hyperactive, and present poor sleep and memory problems. The same cannot be said for crack and cocaine exposure. A child who has this type of withdrawal may have language delays and other serious medical problems, such as increased risk of stroke. Nearly 25 percent of pregnancies in which the mother abused a substance involve marijuana. These children may have decreased fetal growth and be born with smaller heads. Delays in IQ development are unlikely, although the child may struggle academically, particularly with hyperactivity, inattention, and problem-solving. The most common drug exposure during pregnancy (besides alcohol) is to cigarettes. Smoking during pregnancy accounts for up to 30 percent of full-term infants born in the U.S. weighing less than five-and-a-half pounds at birth. Developmental delays are not seen, but these children have an increased risk of sudden infant death syndrome (SIDS), asthma, and attention deficit hyperactivity disorder (ADHD).

Diagnosis and Treatment

Urine drug screens are often ordered after a child is born, to document whether he was exposed to prenatal drugs. This test reports only the 72 hours prior to his birth, and will not detect long-term usage. More accurate is the evaluation of a child’s meconium (the earliest stools), which can reveal maternal drug use up to five months prior to the child’s birth. In a few severe instances — when a child presents respiratory problems or the inability to be consoled — the child may be started on medication, such as methadone, to lessen the symptoms of withdrawal. A hyper-vigilant baby may be soothed with milder medications. The degree of withdrawal varies from one infant to the next, and does not predict future impairments in a child’s development. Some kids with severe withdrawal do wonderfully, while some show no withdrawal symptoms, but face challenges later on. Do not assume that nothing can be done. Research shows that almost all children do well when placed in loving, stimulating homes. Parents who proactively identify their children’s needs early on, and get the help they need, will see their children thrive. Explore all available resources: If you notice symptoms or a test confirms prenatal drug exposure, you should be referred to Early Intervention (EI) services right away. Such programs are highly effective for infants with developmental delays, and they are available at little or no cost to those who qualify. Mental-health professionals can help parents cope with difficult behaviors. Speech therapy, occupational therapy, or physical therapy may be necessary.

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