Should you adopt a child who has been exposed prenatally to alcohol or drugs? What are the short and long term impact of drinking during pregnancy or use of methamphetamines, opioids, Methadone, Suboxone, marijuana, and tobacco (cigarettes or vaping)? We talk with Dr. Julia Bledsoe, a board certified pediatrician specializing in adoption and prenatal exposure. She is a professor at the Univ. of Washington in General Pediatrics, and also the faculty pediatrician at the UW FAS (fetal alcohol syndrome) Clinic, the longest standing FAS center in the US. She is also an adoptive parent.
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Should you adopt a child who has been exposed prenatally to alcohol or drugs? What are the short and long term impact of drinking during pregnancy or use of methamphetamines, opioids, Methadone, Suboxone, marijuana, and tobacco (cigarettes or vaping)? We talk with Dr. Julia Bledsoe, a board certified pediatrician specializing in adoption and prenatal exposure. She is a professor at the Univ. of Washington in General Pediatrics, and also the faculty pediatrician at the UW FAS (fetal alcohol syndrome) Clinic, the longest standing FAS center in the US. She is also an adoptive parent.
Please leave us a rating or review RateThisPodcast.com/creatingafamily
* Note that this is an automatic transcription, please forgive the errors.
Speaker 2:Welcome to Creating a Family talk about adoption and foster care. Do as a favor and let your friends know about this podcast. Most people find out about podcasting and certainly about individual podcasts from their friends, so do us a favor, If you've got anyone in your life that is interested in adoption or foster care, let them know about the creating a family podcast and we thank you from the bottom of our hearts. Today we're going to be doing an introduction to prenatal exposures for those considering adoption. We'll be talking with Dr. Julia Bledsoe. She is a board certified pediatrician specializing in adoption and prenatal exposure. She is a professor at the university of Washington and general pediatrics and she also works as a faculty pediatrician at the university of Washington fetal alcohol syndrome clinic, which is the longest standing FAS center in the U S and the cherry on the cake here is, she's also an adoptive mom of two. So welcome Dr Bledsoe and thank you so much for talking with us today about what is a very important and confusing topic, honestly for people who are just beginning the whole process.
Speaker 3:Well thank you for having me. So perspective adoptive parents considering really any form of adoption, be it domestic incident to foster care adoption or international adoption, often need to consider whether they are the right family to adopt a child with prenatal alcohol or drug exposure. So one of the, the, I think the myths is that going into adoption you're going to have lots and lots of information. So let's talk about what type of information is often available for parents when making this decision. And it might help if we break it down into the different types of adoptions. So for those considering, uh, let's start with domestic infant adoption, how accurate is the information? How much information is known about maternal alcohol or drug use during pregnancy?
Speaker 4:Well, one of the issues with any adoption, but domestic adoption specifically is that sometimes we get quite a bit of information about birth mom. We can get prenatal records, sometimes birth father and extended family history, but that's not always the case. It is extremely variable. So sometimes we have that information and sometimes we don't. When we do have that information, sometimes birth mothers are very straightforward about their use of substances and sometimes because of shame and guilt, they don't disclose accurately what exactly they're using during pregnancy
Speaker 3:shame, guilt and fear. Because I think fear that if they acknowledge that somebody won't choose them and won't choose to adopt their child, I think that's correct. Yeah. Okay. So it really just depends on, you just have to go in with the assumption that you may not know. All right. Let's talk about foster
Speaker 4:care adopted from foster care with children, you'll come into foster care. You know, there has been a big increase and with parental alcohol and drug use, there's been a big increase in the number of kids in foster care. So often children in this day and age, we know they're in foster care because they've been taken from parents who have addiction issues and are struggling with substances. So often we at least have some information about what substances have been used in the birth home and the potential impact on those kids. And we're going to come circle back around to this, but maybe now it'd be a good time to introduce it. So oftentimes, I mean you certainly can have an infant, a even a newborn placed with you from foster care, but you could also have an older child in our toddler, har preschooler or school age child. How often do you have information then? Because at this point you have a child that is is a fully formed child, if that's not an oxymoron, so that to help you make an understanding of how impacted this job might be. So is that helpful at that point when it's an older child or even a toddler? Well, you know, it's interesting with older children, sometimes it's challenging to tease out what's the impact of that prenatal substance use, what birth mom use during pregnancy versus what adverse child experiences the kid has experienced because sometimes the behavior and learning problems we see in older children in foster care are older children that come to be adopted. Those behaviors can be either prenatal exposures or because of some of the neglect, abuse, trauma history that these kids had, so can be very difficult to tease it out. I think people don't realize that some of the same things we see with prenatal exposure are often seen with children who have a history of trauma in their background. Yes, and it's what can make this field very, very tricky. Yeah, it does because parents, understandably one answers. I mean, they want things to be black and white when in fact we often don't have that. All right. Let's talk about international adoption then. So let's talk about what parents will often, what information they will have when making the decision on whether or not they're the right family for a child with international adoption. The information that's available really varies by country. We have a country like Korea, which often takes very detailed and interviews the birth mother and gets very detailed information about substance use and alcohol use and how much was used versus a countries like Africa or China where the children are abandoned or relinquished without any family history or prenatal history. And then we have children in the Eastern European block, like bull area. Russia of course is close, but will Gary in the Ukraine where we know there are high rates of alcohol use during pregnancy, but we may not have that documented
Speaker 3:[inaudible] so for the older children internationally, uh, does, we've already talked about signs or symptoms and the child themselves that may indicate exposure, prenatal exposure to alcohol or drugs. What about internationally? Are there, uh, signs and symptoms there that parents can look at or is it similar that it's hard to tease out?
Speaker 4:Well, we certainly know when we're thinking about prenatal alcohol exposure that children exposed to alcohol prenatally can have either facial features or growth efficiency. That can be a little bit of a clue when we're looking at the paperwork from international adoption. We can look at those things and say, gosh, that sort of increases the likelihood this was an alcoholic spouse child. However, sometimes you know, living in an orphanage setting can it impact your growth and so that's not as helpful. But we often will use facial features or you know, history of birth mother perhaps using alcohol.
Speaker 3:So[inaudible] international, you may have that information. Yes. Okay. You know, one of the things that, uh, there in the past was perhaps greater emphasis on the facial stigmata the face of a child who has fetal alcohol syndrome or fetal alcohol spectrum disorder that then upper lip the eyes, it'll look a specific way. How accurate is that as a method of predicting and what does the absence of that mean?
Speaker 4:That's an excellent question. And we know that the facial features that you've described, a very fin upper lip, the absence of that crease between the nose and upper lip and a small width of the opening of the eye itself, those three features, the features of fetal alcohol syndrome are formed in a very, very small window of time in pregnancy, a three day window between days 18 and 21 so if you can, if you can imagine a birth mom who drinks in a binge pattern and misses those days can still produce a child with brain damage but they have a normal face. We do know, you know, after 40 years of research, more than 40 you know, fetal alcohol center was described in 1973 and we now know that there are some predictors, you know, if you have an alcohol exposed kid, there are some predictors of poor brain function. And those predictors are if you have the face of fetal alcohol syndrome or if you have significant growth deficiency because alcohol exposure can cause kids who grow very poorly. And the third thing is a very small brain size. And if you have any one of those three things or all three of those things like in full blown fetal alcohol syndrome, the chances are really good that you'll have a lot of brain problems
Speaker 3:and okay, so brain size is the only way of telling absent some type of visual imaging, a cat scan or whatever would be head circumference.
Speaker 4:That's exactly right. All right, and when we talk about growth deficiency, are we talking height? Are we talking weight? What are we are both both height and weight. Although height tends to be the most impacted if you have fetal alcohol syndrome.
Speaker 3:Okay, and so it would it be possible actually for, I mean this is pretty hypothetical, but for a child that has the, the facial features that are indicative to not have significant brain damage simply if the mother was drinking heavily between day 18 and day 21 which honestly is to a certain is before many women would even know they're pregnant.
Speaker 4:True. It is possible for you to have the face of fetal alcohol syndrome and not have a huge amount of brain damage. It's possible that not have the face of fetal alcohol syndrome and have a lot of brain damage. And maybe I could explain why. If you think about the brain as a circuit board of wires, depending on how much birth mom drank and when different wires are going to be clicked, right? So we see children exposed to alcohol who can have areas of strength right next to areas of weakness in terms of brain function. So it can be very confusing to people because I sort of think of it a little bit like Swiss cheese brain is you've got, you know, these different areas that are impacted. We also know that there are some babies that seem to be resistant to the effects of alcohol in the womb. And right now we just recently published a paper where we looked at twins and identical twins exposed to alcohol in the womb, have the same outcomes. Fraternal twins even bathed in the same broth because they're different, genetically have different outcomes. So it's a little bit challenging to predict, as you can imagine, because there is something at the level of the baby themselves that seems either protective or not protective against the effect of alcohol.
Speaker 3:That is absolutely fascinating. So let's talk about some about the amount or the timing of the alcohol use. We hear a lot that, you know, we certainly know that there are countries where having a glass of wine with dinner is just a part of the culture. And yet we also know that alcohol can significantly, well, it causes brain damage is what it does. So what do we know from science as to the amount and then the timing in the pregnancy or the pattern of drinking and how that impacts children. And we will stipulate it to beginning that all every medical society that I know of says that there is no safe amount of alcohol during pregnancy. So you should not drink during pregnancy. So we'll, we will, we'll establish that as our baseline. But,
Speaker 4:uh, so what do we know about the timing and the amount or the pattern of not speaking only of alcohol at this point of alcohol consumption and how it impacts the brain of the fetus? Well, we do know that in terms of timing and pregnancy, the most vulnerable period for that developing central nervous system, which is the brain in the spinal cord, is that first trimester. And so the children at most risk for longterm brain damage and significant longterm effects are children who are exposed to heavy drinking during the first trimester. There are changes that occur to the brain later on in pregnancy, but they tend to be a little more subtle in terms of growth of different types of the brain and the neurotransmitters, the little chemicals in the brain. But really during the first trimester, that's the most vulnerable period. And when alcohol is known to be a true poison, a toxin to the developing central nervous system, the babies who are at most risk heavy regular use during pregnancy, but binge drinking, which is you know, three to five drinks per occasion can also have significant impact in terms of brain damage early in pregnancy and does it, is it different with drug use and we're going to in a minute break down and talk about different types of drugs. Does it differ with the or is it the same as that? The a large quantity and persistent over time that causes the most damage is for all of these chemicals, large doses and persistence over time. Just as you put it, really heavy, regular use that really is the most damaging to the developing fetus. Okay. I will say, because remember there are these differences between babies and how they respond. That's one of the reasons we say there is no known safe level because if you have a fetus who is exquisitely sensitive to substances, then they may have more damage than a baby who is more resistant. We also know that it's a little bit dangerous to tell women who are prone to addiction, that it's okay to drink during pregnancy because they may underestimate or be in denial about how much of the problem they have or how significant their drinking. And that makes very good sense.
Speaker 2:We remind everybody that this show is underwritten by the jockey being family foundation. Their mission is post-adoption support and one of the ways they do post adoption support for families is through their backpack program. It's a free program to agencies and attorneys and judges and court clerks. You can sign your family up, the agency can sign there for newly adoptive families up to receive a customized backpack. It's customized with the child's initials. Inside is a plush bear and a cuddly blankets. And then there's a parent tote with parenting resources. It is free for the parents. It is free for the agency. Uh, it is jockey being family's mission. You can get more information and let your agency know to sign up are, if you're an agency rep, you can sign up yourself at the jockey being family doc,
Speaker 3:calm website. Just click on backpack. All right, so now I want to talk about both short term as well as longterm impacts. What we know from research. And I'm going to break it down by substance. We've been talking about alcohol and you've, so let's start with that one. Uh, and the first question, let me ask, is the impact for the child, does it matter the type of alcohol, whether it be wine, beer, are hard, liquor,
Speaker 4:well alcohol is alcohol and so certainly the form of it is not as important as how much is consumed. So one beer obviously is not the same proof as a shot of liquor, but still that exposure is there. So, so all forms of alcohol we sort of consider dangerous to the developing fetus.
Speaker 3:Okay. Cause alcohol is alcohol. All right. And you've talked about that. You described it as as a circuit board where some circuits work and some don't and they can be circus going, lying right beside each other. So we see an inconsistency in development for children who have been exposed prenatally to alcohol. So that's one symptom. And then you've talked about impaired growth. Does that impaired growth? Is that both in infancy as well as later in life?
Speaker 4:It can be at any point. We know that baby's exposed to alcohol and pregnancy can grow poorly in the wound, but also outside of the wound.
Speaker 3:Okay. Small head circumference, again, that would be a smaller brain, let's just say a smaller brain measured as, as measured by head circumference. Is that also both short and longterm?
Speaker 4:Yes. And the brain damage that is done by alcohol is permanent. I think that's the other thing that's quite scary about it is that the areas of the brain, uh, some are more effective than others. You know, if we look at things like functional MRI, some of the areas are smaller than others and it's not like we can undo the damage.
Speaker 3:[inaudible] so what would we see? We would see, um, so describe some of the symptoms, either short term list. We'll start with short term, an infant in the first year or so of life, there's an infant with uh, uh, fetal alcohol spectrum disorders. And, and it's important to note that the reason it's called fetal alcohol spectrum disorders is because it is on the spectrum with full blown fetal alcohol syndrome at one end, but any permutations of impact can fall anywhere along the spectrum. So, okay, let's say let's talk with short term, anything specific that parents need to know about the short term impact of prenatal alcohol exposure?
Speaker 4:Yes. We know that babies with fetal alcohol spectrum disorder can often have a lot of difficulty in the newborn period with typical baby regulation. They often can have difficulties with the suck swallow reflex, which leads to feeding difficulties, which sort of further makes growth a little more challenging. They can be very difficult to soothe and so these are babies that often have some sleep difficulties in that infant period and really need to be swaddled, need to be held a lot sort of difficulty with just typical baby behaviors
Speaker 3:[inaudible] but perhaps more extreme in the in the inability to become fritted. Yes. Okay. Now let's talk about some of the longer term impacts as as these babies grow into preschoolers and school age and, and on up through tweens, teens and adulthood.
Speaker 4:Yeah. And it's interesting that because the part of the brain that's most impacted by alcohol is the part of our brain which governs what we call higher order thinking. Things like attention, problem solving, impulse control, being able to recognize cause and effect. Those are the areas of the brain that we really, you know, don't come online until kids are around school age, right? We allow preschoolers to be a little hyperactive and inattentive, but really when they're expected to be in school and to do these higher order thinking skills, problem solving skills, language skills, that's when we really see them start to struggle. And so a lot of kids with, even with full blown fetal alcohol syndrome can look pretty good. And the preschool period, you know, and toddlerhood and preschool period. And then it's really in school where we start to see their challenges because of that higher order thinking effect.
Speaker 3:Um, any behavioral issues associated with children? Are they harder to apparent because of behavioral issues?
Speaker 4:Again, when you're sort of thinking about, uh, impulse control, hyperactivity, mood dysregulation, uh, so temper tantrums, those are behaviors that we often see in higher rates and kids expose alcohol prenatally. And those can be very challenging to parent. How do you discipline a child who doesn't get cause and effect? For example,
Speaker 3:[inaudible] and, and, and oftentimes we talk about them being primary symptoms and secondary symptoms with the secondary symptoms being oftentimes the behavioral things from otologist simply not being understood that their language may be very high. So people make assumptions, their language capabilities may be very high and yet their reasoning, their higher level reasoning and their, uh, their ability to understand cause and effect ability to understand time and money and things such as that may be lower, but the secondary discipline, uh, behavioral issues may come from being misunderstood less than from the actual impact on the brain. Do you see that as well?
Speaker 4:Yes, absolutely Don. And I think one of the challenges for these kids is that it is an invisible disability. Even if they have the face of fetal alcohol syndrome, that face is just cute and doesn't give you a clue as to the amount of disability a child has. But the things we absolutely know are very common in kids with on the fetal alcohol spectrum or lower IQ, attention deficit and hyperactivity disorder, language challenges, impulse control challenges. Those can make a child look like they won't do something when in reality they can't. And so sometimes our major intervention with teachers or with caregivers is to say, you know, this is not necessarily willful behavior. This is brain-based behavior that we have to cope with. So the child isn't always in trouble. Right. Or starting to feel terrible about themselves.
Speaker 3:Is there good research that's available that differentiates children who had been raised in the alcoholic home? Are they a home that where alcohol is being abused, let's put it that way. Versus children who are removed and raised in, in this case, most likely it would be an adoptive home where they've got stable parenting and resources and as far as how the children do and fare later in life.
Speaker 4:That's an excellent question. We're still waiting for the longest term research project of that to be published. But we absolutely know when we look at intervention for kids on the fetal alcohol syndrome, a syndrome that by far the most important thing is a stable, structured, nurturing home and early identification of children who are on the spectrum. Those predict a better outcome. And so, you know, the 1970s sort of landmark study by Ann's dry goose that talked about, Oh these are kids that always end up in trouble with the law. These are always kids that end up, you know, with mental health issues. I think we can prove those wrong if we have, you know, the beauty of foster and adoptive care, which is stable, structured, nurturing home with understanding the kids and getting them the services they need early on.
Speaker 3:Yeah. Which is part of what this is, is educating parents. So to go in with the expectations so that they can get early, get their child services early and so they can understand the distinction between can't and won't and that they can parent to that. So that some of the secondary issues of depression, anxiety and, and behavioral issues, um, don't, are not necessarily a given.
Speaker 4:I think the other thing that we always worry about with these children is remember if you're exposed to alcohol or drugs in the womb and you are born to a birth parent with a history of addiction, you're sort of dull, doubly vulnerable to your own development of substance use later on in life. So we also know that children who are adopted into a home that is mindful that addiction can run in families just like art disease, that you are very clear about your messages to kids, particularly in their teenage years. And to give them a strength so that they don't turn to alcohol and substances themselves
Speaker 3:[inaudible] and understand their own, uh, sensitivity perhaps to addiction. Exactly. Right. Exactly. All right. Let's now talk about some of, uh, other drugs. Let's start with methamphetamines. I, we, we hear so much about other drugs right now that, uh, meth often gets overlooked and yet in many parts of the country it is still the predominant drug of choice. So let's talk about methamphetamines. What do we know about how they impact, uh, children both in the short term as well as longterm.
Speaker 4:Methamphetamine unfortunately is the least studied of all of the substances of abuse. We have studies that have followed these kids, uh, through sort of early school, sort of early school age children. And what we know about methamphetamine use is that it can cause a withdrawal pattern in the newborn period. Again, withdrawal and babies looking like difficulty feeding difficulty, self-soothing, sort of jittery, uncomfortable babies. But uh, the school aged children, the effects we're seeing are primarily on learning. It does not appear at this point in time to have an impact on our IQ. And it doesn't seem to cause a pattern of birth defects in kids, but it can have some subtle changes in terms of learning disabilities, particularly for intention. And you know, attention deficit hyperactivity disorder is something that we're seeing in kids exposed to heavy methamphetamine use and pregnancy. So the jury is still out. Jury's still out.
Speaker 3:More research needed. Okay. All right. We certainly are hearing a lot about opiates and opioids, both prescription and illegal. So let's give some names to the prescription opiates and opioids and the legal and the illegal. Let's give the, uh, what are some common names so people know.
Speaker 4:So certainly for prescription drugs, obviously Oxycontin or oxycodone, those are medications that are, have been used primarily for medical reasons, but people can abuse them is one form. And then also for women with substance use issues who have addictions to opiates, we use methadone, what we call methadone maintenance treatment as well as Suboxone is become a little more popular, which is also used sort of as maintenance to keep people from using heroin in particular. So with Suboxone and methadone for women who are on those medications, we know that after birth, these are children who can go through withdrawal, what we call neonatal abstinence syndrome. And because they are longer acting opiates than heroin, that withdrawal can take a little bit longer to show up. So sometimes these are babies, these are babies who really should be monitored in the nursery for longer than we typically do to watch for evidence of withdrawal, you know, at five, six, seven days of age.
Speaker 3:Well, one of the questions I would have is when methadone or Suboxone is used as part of the treatment for substance disorders, it is a steady monitored dose was also usually so you know what you're getting. It's not infiltrate, uh, doesn't have other substances that have been mixed in but it's also a steady and a predictable dose. Does that change the way it, it's impact, there's not binge use generally that's why they're on this as a, uh, as a treatment
Speaker 4:protocol. Well, what we know about opiates is that in terms of their impact on the developing central nervous system of the fetus, they are probably always sounds strange to say much safer. Well they are much safer than alcohol and they're probably in some ways the safest drug. They certainly have a profound impact on withdrawal in the newborn period, which can be very stressful and even life threatening to the baby if not treated. But in terms of affect on IQ, in terms of effect on learning, those effects are really minimal. And the longterm impact of opiate use in general is very mild in terms of its effect on learning and behavior. Down the road.
Speaker 3:It is so, such an interesting dichotomy, isn't it? Let us also mention that the illegal substance opioids would be include heroin and fentanyl. So that just so parents will know what names that we're talking about. All right, so there doesn't seem to be, or am I understanding correctly that whether or not you're using a prescription or whether you're getting your opioids illegally, it doesn't seem to matter as far as the impact?
Speaker 4:No, not of it is just opiate use.
Speaker 3:Okay. Well that's an interesting, let's talk about that. How often is it multiply abuse
Speaker 4:and Dawn, you know, the, that question sort of brings up why it's so difficult to study the law. The effects on kids, uh, of the substances is often, uh, there is polysubstance use. And so when we see a record where a birth mom's using heroin or methamphetamine, we always have to worry that there are other substances involved. So polysubstance use is a real problem and makes our field very challenging. But you know, usually women who are addicts will tell you they have a drug of choice. One that's more used than the others. So you can have some sense of what the impact may be on the fetus
Speaker 3:and to, if I'm understanding you correctly, that if they're heroin user, they may not necessarily, it's not necessary that you could make the assumption that they're also going to be abusing alcohol.
Speaker 4:Right. You cannot necessarily make that assumption.
Speaker 3:Okay. All right. So the opioids before we leave the children who are a born dependent and have been diagnosed with neonatal abstinence syndrome in a S the first question I have is about how long do the symptoms of NAS last. Um, so parents know. All right, so I'm, I know what I'm getting into cause I know bad how long this is going to last and I can get extra help and support during that period.
Speaker 4:And in general, again, that's a little bit dependent on what's being used. Those longer acting ones, Suboxone and methadone, it can sometimes take a little bit longer for the baby to withdraw from those long acting substances. So sometimes we're talking as long as two to three weeks, uh, in the, uh, newborn nursery or the new natal intensive care unit. Um, and each fetus is a little, you know, each baby's a little bit different in terms of how they are withdrawing. Uh, but in general we would say for much, for most families we're looking at seven days to 21 days of care. Uh, that's really specialized for withdrawal newborn period.
Speaker 3:And the last question on opiates, I think a lot of parents assume that if their child is not born dependent upon any drug, that that means that the child will have less impact. Is that a, is that a good assumption?
Speaker 4:Well, when we're, when we're thinking about opiates, that's probably a good assumption. Uh, when we're talking about something like alcohol, it's not, there are many babies who, whose birth moms drank heavily during the first part of pregnancy and they look okay at birth because mom cut down or didn't drink in the last part of pregnancy. But those again are babies that can still go on to have a lot of longterm development and behavior problems. So they need to be monitored very closely.
Speaker 3:Well also if a, if a mother is for whatever reason gets into treatment and gets off the drugs towards the end or is incarcerated and is not, he doesn't have access to the drugs. The child may not be born dependent. But what is still had the impact in the trimesters before she stopped using?
Speaker 4:Yes. Okay. And I, you know, I always counsel families that if you have a child, if you're adopting a child or fostering a child who is exposed to alcohol or drugs prenatally, our job is to watch them like a Hawk at every level of development so that if they do issues that arise that we can jump on them right away. So we never sort of view it as a wait and watch approach. We just monitor their development very closely and be on the lookout for those learning and behavior issues as they grow.
Speaker 3:Okay. A drug I think we're going to be hearing more about, so it's, it's now becoming legal more places is marijuana and because it's becoming legal, it may be being used more in pregnancy. So what do we know about the impact of marijuana? On a fetus, both, well, both short and longterm.
Speaker 4:Well, marijuana, like you say, is, is becoming legal in many parts of the country. And one of the challenges in looking at the research about marijuana is that the marijuana people are using today is a lot more potent than it was in the past. So the studies that we have are probably an underestimate of issues that kids can have down the road. We know that babies whose moms smoked marijuana heavily during pregnancy are mostly at risk for longterm learning and behavior issues. Again, they tend to struggle most with attention. There's an impact of marijuana longterm on what we call spatial reasoning. So often kids struggling a little bit more with math and there are some effects that we can see down the road on language with language learning disabilities. So it is far from the sort of safe, benign, um, legal quote unquote substance that, that we would hope. So, again, something that, that people need to be very aware of and very careful of when they use during pregnancy. It's also concentrated in the breast milk. So, uh, breasts, women who breastfeed after pregnancy have to be very careful about their marijuana use.
Speaker 3:Oh, that's interesting. So what about, uh, what about the, is alcohol present in breast milk? This would only come up in adoption, right? Well, I suppose it would come up if in newborn infant if the breath, if the birth mother breastfeeds the first week or something to allow the colostrum and other beneficial aspects of breast milk or in foster care where she may have breastfed before the child was removed or international as well. So what do we know about alcohol and breast milk?
Speaker 4:Yeah, we certainly know that alcohol also passes through the breast milk. It's not as in high amounts as it is in the bloodstream of the birth mom. And the impact for breastfeeding infants on those things is more sort of in, in how they develop outside the womb rather than inside the womb. So it can delay their development because they are experiencing that outside the womb. It's not as much the brain damage that is done as the impact on development because of their, with the environment.
Speaker 3:All right. And opioids and opiates do they pass through the breast milk as well.
Speaker 4:They can pass through the breast milk as well and they can sort of suppress development in the same manner as the other two.
Speaker 3:Okay. All right. So we've talked about alcohol, meth, opiates, both illegal and illegal marijuana. What about how just call these others ecstasy inhalants and things like that? Have they been studied much?
Speaker 4:Well, ecstasy has not been studied very well in terms of the impact of the developing fetus, inhalants. We certainly know that there's some geographic differences in this country in terms of where inhalants are used, but the research is really spotty in terms of the longterm impact on, on learning and behavior in kids. So those really are in some ways they're risky for use because we don't know as much. Right. And so people again, certainly would follow kids exposed to those things closely over time.
Speaker 3:All right. And something that, the last one I want to bring up is something that's often not considered a drug. And that would be tobacco. And I think we should talk about both smoking as well as vaping cause we certainly know that vaping is very common right now. And uh, so yeah. So let's talk about tobacco. Is it a drug visit? A drug that we need to worry about?
Speaker 4:It is a drug that we need to worry about and it's one of the best studied of all of the drugs because it's certainly been around a long time. And of course the active ingredient in tobacco and in vaping that we think about as nicotine and nicotine has a very well known impact on growth of the baby in the womb. It really causes, it can contribute to prematurity, but it causes low birth weight. And we do know that nicotine is known to have effects down the road in terms of learning and behavior there of course not as dramatic as we see in alcohol, but they are there. And we also know that in birth moms who have smoked tobacco heavily during pregnancy, their children are at increased risk of heart disease in middle age. So it is an impactful substance. We also know that there is not a nicotine withdrawal after birth, which you would think that would be the case.
Speaker 3:Yeah, you would think so because certainly there is for people trying to stop smoking. So that's interesting.
Speaker 4:Yeah. I think, you know, pediatricians and obstetricians are very worried about vaping and I think we're just starting to see why with the news of these people with lung disease related to vaping is we just, this is a new phenomenon and we just don't know what all the chemicals that people are inhaling into their lungs are going to cause for themselves or if they happen to be pregnant for their babies. So there's a, you know, obviously we have the same concerns about nicotine. People are vaping nicotine or people are vaping marijuana. But we, I think we're all a little bit worried cause we don't, we just don't know what those other chemicals will do to do the developing fetus
Speaker 3:or even what those chemicals are. Yes. Right. Okay. Excellent.
Speaker 2:All right. In addition to the jockey being family as our underwriter, we also have partners, uh, that helps support this show. And these are agencies that believe in our mission of providing unbiased, accurate information both pre and post adoption because it's in the best interest of kids. One such partner is adoptions from the heart. They have helped build over 6,000 families since 1985 through domestic incident options. They work with families all across the U S and they are fully licensed in Pennsylvania, New Jersey, New York, Delaware, Virginia and Connecticut. All right, so dr Bledsoe, we are talking,
Speaker 3:talking about the impact of prenatal exposure and we're, we're focusing on kind of an introduction to what people need to think about if they're considering adopting a child. So oftentimes these parents are, or they're, they're presented with a match or a referral, uh, and they, they may not have full information, but they may have thought they may be enough information that they have concerns that the child might have been exposed. So what should parents consider when trying to decide if they're the right family for a child who has been exposed prenatally to alcohol or drugs?
Speaker 4:That is an excellent question and I think sometimes very challenging. We definitely know that if you adopt a child with prenatal exposures, sometimes in that referral or you know in the documents you receive for the pre adoptively is often there are clues for us that will sort of tell us does this look like a child that will have severe severe learning and behavior problems related to substance abuse.
Speaker 3:What would some of those clues be? Just give us some examples.
Speaker 4:Oh, you know, if we have a birth mom who is known to be a chronic alcoholic, if we have documentation of how much she typically drinks, whether or not she was intoxicated during pregnancy on multiple occasions. In know, often we do have some clues and you know, if the baby's born and we have photos or we have growth information, we can say, gosh, this is a child who's very concerning, let's say for full blown fetal alcohol syndrome. And in that case I think it's very important for families to think, am I, you know, obviously to me the match for the child is just as important as important as the match for the parents. I think every child needs to be adopted. You know obviously needs a family, but they really need to be adopted by a family who absolutely can go to the mat for them in terms of their special needs. Sometimes we can't predict what those special needs or can be, but sometimes we can and so you know if I, if there is a child who has been exposed to substances in the wound, obviously getting as much information as we can is helpful, but also just sort of playing that through and thinking, you know there could be a range of problems, could be mild, could be moderate, could be severe. What are things that we feel like we can do as a family to really nurture this child and provide the special care that they may need.
Speaker 3:Then you've already mentioned that one of the things that parents need to be prepared for if they have reason to believe that the child has been exposed prenatally is to you. You said watch them like a Hawk. Be prepared to take early intervention, be prepared to watch for and be considerate at every stage of development that is this normal development. Do we need to have an assessment? Do we need to get extra help at this extra therapies or whatever to help the child at this stage.
Speaker 4:The other thing that I think families need to think about is even schools, because you know, obviously if there's a child who's going to require special education services or is likely to require special education services. Thinking about where you live or the school district that you choose can also be certainly important to think about as you're moving forward.
Speaker 3:Is there a, uh, and again I doubt there's research that supports this because I think what it's important to repeat what you said about the greatest predictors of success is a child being raised in a stable, nurturing environment. And I would add educate parents that are educated that this is a potential problem, so stable, nurturing and educated families so that we know that children have a better outcome there. Is there, I wonder is there any evidence of parents who are more flexible as to what their expectations are for, for parenting and, and what this child will ultimately do in their life?
Speaker 4:That's an excellent point. I think, and I will say as an adoptive parent myself, is whether or not we like to think of it. There are some times we have goals for what our children are going to be like and some expectations about what they're going to be like. And I think you know, I have had, when I've done some pre adoption consultations, I've had parents say to me, do you think there'll be able to go to college? Do you think they'll be athletic? Those sorts of things. And you know, if you're looking at kids, particularly with alcohol exposure that could be significant. You really have to reframe a little bit about what your expectations are and think that this may be a child is likely to have some special needs and that you know, your parental expectations may have to be, like you said, more flexible and that, you know, is hard sometimes to think about as a parent. But I think that's a very real phenomenon.
Speaker 3:I think it is too. There's a great deal of evidence that says that the happiest in this case, this is the research for adoptive families, the happiest adoptive families are those where what the parents' expectations are, are met. And so the, the challenges for parents to go into an adoption, realizing that their expectations are part of the issue, that they need to go in with realistic expectations of for themselves and for the child.
Speaker 4:I also think an important piece that I see in the intervention studies for families with children with fetal alcohol syndrome is one of the predictors of feeling like a success as a parent and feeling, uh, bonded and connected to your child is other family support. And I think it is, you know, the families that seem to struggle the most feel like they're parenting a challenging child in isolation. They don't have a parent network support. They don't have extended family, they don't have church support. At least some sort of support where they feel like one, they can recharge their own batteries and get some respite and to share ideas with other people who are going through the same thing.
Speaker 3:So then I'm taking it the next step. Another thing that parents should consider when considering a child adopting a child with prenatal exposure is do you have a support network and a support network that's willing to be educated on the special needs or the special issues this child might bring? Exactly. Right. Yeah. Fascinating. Yeah, I that's a, that's such a very good point. Such an absolutely. Good point. Well, thank you so much dr Julia Bledsoe and dr Bledsoe is a professor at the university of Washington and general pediatrics and she also works at the university of Washington fetal alcohol syndrome clinic. Let me remind everybody that the views expressed in this show are those of the guests and do not necessarily reflect the position of creating a family, our partners or our underwriters. And of course, keep in mind that the information given in this interview is general advice to understand how it applies to your specific situation.
Speaker 2:You need to work with your either your medical professional or your adoption professional. Thank you dr Bledsoe. This has been great. I really appreciate it. It was my pleasure. Thank you very much. Done. And we will see everybody next week.