A National Challenge – Supporting the Development of Young Children Who are Affected by Maternal Substance Abuse


By Linda K. Smith, Deputy Assistant Secretary for Early Childhood Development

This week, we are releasing a Policy Statement: “Supporting the Development of Young Children in American Indian and Alaska Native Communities Who are Affected by Alcohol and Substance Exposure”.   The policy is the result of over a year and a half conversation and intense look into what we know – and don’t know – about the babies born to mothers who use alcohol or drugs during pregnancy.  The policy statement grew out of a visit by our Secretary to two Native American communities in 2015 and a request for help in supporting these babies who are enrolled in our Early Head Start and Child Care programs.  And, although the policy responds to the issue in our AIAN communities, it easily could apply to any state and many communities across America.  Many of our communities are experiencing marked increases in the use of opioids and a commensurate increase in the cases of babies experiencing Neonatal Abstinence Syndrome (NAS).

Of 28 states that examined trends in Neonatal Abstinence Syndrome (NAS), and maternal opioid use, the overall NAS incidence increased 300% between 1999 and 2013.   According to the National Institute on Drug Abuse, a baby is born suffering from opioid withdrawal every 25 minutes.  Newborns that experience opiates in utero may experience NAS and depending on the severity of drug withdrawal, may suffer a number of symptoms as a result.  Generally speaking, the medical focus is short term and primarily focused on getting the infant through withdrawal, and helping the mother accept and follow through on substance misuse and treatment.  Not much attention has been paid to helping the mother understand and learn to care for her baby.  Almost no attention has been paid to other caregivers who may actually care for the babies for extended periods.  Whether they are parents, grandparents, child care providers or Early Head Start teachers they too will need to understand NAS and the accompanying symptoms.

Babies born with NAS are irritable, engage in excessive crying, have trouble with eating and digestion and frequently don’t like to be touched.  This may impact the mother and baby’s ability to bond during those critical first days and weeks.  Most symptoms will diminish as the child gets older, but some symptoms could last for months or longer.  While impacts on cognitive development are unclear, children born with NAS appear to be more likely to have behavioral problems such as poor attention span, hyperactivity and challenges with self-regulation.  They may be very sensitive to light and sound and require environmental modifications.

Findings from those studies that have been done indicate that long term effects are highly dependent on the quality of the caregiving environment, which suggests that the effects can be mitigated with access to appropriate supports.  Although there is more that we don’t know than what we do, one thing is certain, being aware of the problems and potential symptoms can help adults who work with either NAS or Fetal Alcohol Spectrum Disorders (FASD) babies provide the best possible environments and care to help these children develop.

While I have focused here on the NAS challenges, the policy addresses children affected by any substance abuse during pregnancy including Fetal Alcohol Spectrum Disorders (FASD.)  According to the Institute of Medicine, “of all substances of abuse (including heroin, cocaine, and marijuana) alcohol produces by far the most serious neurobehavioral affects in the fetus”.   It should be clear that providing preventive, educational information and services to expectant mothers is a top priority.

I urge everyone, whether you work with AIAN families or not, to read this policy statement and share what you know about programs or training for adults who care for NAS/FASD affected children.  What works, what doesn’t?  Until we know more, we must learn from each other.   Finally, it is vitally important to raise awareness about the effects of substance abuse on both the mothers and their babies.

Look for the Policy Statement on the ACF’s website. It will be posted as soon as possible.

Source: Administration for Children and Families, Early Childhood Development

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