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

Opportunities to Promote Children’s Behavioral Health: Health Care Reform and Beyond: Workshop Summary 


The Patient Protection and Affordable Care Act (ACA), which was signed into law in 2010, has several provisions that could greatly improve the behavioral health of children and adolescents in the United States. It requires that many insurance plans cover mental health and substance use disorder services, rehabilitative services to help support people with behavioral health challenges, and preventive services like behavioral assessments for children and depression screening for adults. These and other provisions provide an opportunity to confront the many behavioral health challenges facing youth in America.

To explore how the ACA and other aspects of health care reform can support innovations to improve children’s behavioral health and sustain those innovations over time, the Forum on Promoting Children’s Cognitive, Affective, and Behavioral Health held a workshop on April 1-2, 2015. The workshop explicitly addressed the behavioral health needs of all children, including those with special health needs. It also took a two-generation approach, looking at the programs and services that support not only children but also parents and families. This report summarizes the presentations and discussions of this workshop.

Source: The National Academies Press

Available at: http://www.nap.edu/catalog/21795/opportunities-to-promote-childrens-behavioral-health-health-care-reform-and

‘Crack baby’ study ends with unexpected but clear result – Philly.com


Jaimee Drakewood hurried in from the rain, eager to get to her final appointment at Children’s Hospital of Philadelphia.

Ever since her birth 23 years ago, a team of researchers has been tracking every aspect of her development – gauging her progress as an infant, measuring her IQ as a preschooler, even peering into her adolescent brain using an MRI machine.

Now, after nearly a quarter century, the federally funded study was ending, and the question the researchers had been asking was answered.

Did cocaine harm the long-term development of children like Jaimee, who were exposed to the drug in their mother’s womb?

The researchers had expected the answer would be a resounding yes. But it wasn’t. Another factor would prove far more critical.

via ‘Crack baby’ study ends with unexpected but clear result – Philly.com.

Sensitivity, Screening, and Support: Talking with Expectant Families about Substance Abuse


Fetal alcohol spectrum disorders (FASDs) are the leading known cause of mental retardation, and they are entirely preventable. This audio conference discusses the chance Early Head Start staff working with expectant families have to help prevent FASDs. Panelists share insights and strategies about approaching this sensitive topic. They also give guidance on supporting families in making informed, healthy choices around alcohol use during pregnancy.

Source: Early Childhood Learning and Knowledge Center

Available at: http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/ehsnrc/Early%20Head%20Start/early-learning/assessment/SensitivityScre.htm