Editors

SarimariTupola

Monitoring a Child of a Substance-Abusing Mother

Substance abuse during pregnancy: see Pregnant Substance Abuser
Parental substance abuse will always have both immediate and long lasting adverse effects on the child.
Some mothers are able to conceal the abuse during pregnancy, others may be able to reduce the use temporarily or even to stop it totally. The mother may try to hide her history of substance abuse, for example by moving to a new region.
Consider the possibility of substance abuse if
- the mother's appearance and/or behaviour are suggestive of substance abuse or intoxication is witnessed
- antenatal care is sought later than is usually expected
- visits to the antenatal clinic, or later to the Child Health Clinic, are repeatedly missed
- the mother tests positive for hepatitis B or C, or HIV.
- previous children have been removed from parental care.
Even when the follow-up is managed by a paediatric unit within specialized care, parallel routine monitoring at a Child Health Clinic within primary care remains important. Co-operation between different health care units and child protection authorities is essential.

Poor physical health
Poor nutritional status
Failure to comply with contraceptive measures (a subdermal contraceptive implant is the method of choice, see Contraception: Initiation, Choice of Method and Follow-Up)
Infections (hepatitis, HIV)
Depression and other mental health problems
Financial problems, unemployment, limited social network, no permanent partner or involved in a violent and dysfunctional relationship, criminal activity, violent behaviour.

Contraindicated:
- Substance abuse on-going
- HIV positive mother
May be considered:
- Substitution therapy is not an absolute contraindication.
- A hepatitis B positive mother may breast feed provided that the infant has been vaccinated Viral Hepatitis.
Breast-feeding is not likely to increase the infant's risk of contracting hepatitis C from the mother.

Record fetal exposure to medications, alcohol, drugs of abuse and tobacco.
An extensive physical examination and age-appropriate neurological examination
- Undress the child and examine the skin in its entirety.
- Asses the state of alertness.
- Observe the interaction between the child and the carer and how the child's needs are taken into consideration.
Ask questions about the child's crying habits, nutrition and daily routine as well as the parent's resources.
FASD Fetal Alcohol Spectrum Disorders
Exposure to illicit drugs may be associated with
- delayed growth of head circumference
- acute withdrawal symptoms
- subacute (lasting 3-6 months) withdrawal symptoms
- possibly an increased risk of sudden infant death syndrome
- neglect and other maltreatment
- psychiatric problems
- difficulties at school
- disturbed speech development
- social problems.
It is considered that growing up in a family where alcohol or other drugs are being abused has a more negative impact on the child's emotional development than prenatal drug exposure. Moreover, environmental factors play an important role in the long-term prognosis of a child with FASD.
Note any signs of possible neglect (e.g. hygiene, clothing, skin condition, the child's attitude towards the examiner) or maltreatment.
Check the state of teeth and mouth, and refer the child to a dental hygienist or dentist as indicated.
Verify the hepatitis state and other infections.

Talk about the family situation in a matter of fact way, but remain polite and respectful to the child and the family.
- Other children, day care, the relationship between the parents, employment, lodgings, violence within the family, attitude towards physical punishment, susceptibility to irritability when taking care of the child, substance abuse, possible care facilities attended by the parents
In certain circumstances the parents should be asked on a regular basis about their substance abuse, or whenever a suspicion of abuse arises.
If necessary, report the child to the appropriate child welfare authorities or consult them to assess the need for support.