Our Baby Was Exposed Prenatally to Substances. Should I Worry? - Weekend Wisdom

Question: Our adopted son is almost 4 months old and perfectly healthy. He eats well, sleeps well, and seems to be hitting his milestones just fine. We know that he was exposed to cocaine during pregnancy, but he was born only three weeks early, which is still full-term. He had a healthy birth weight, he was not suffering from withdrawal in the hospital, and he has checked out as perfectly healthy at all of his pediatrician visits so far. My question is, does the lack of negative effects of cocaine in these early months of his life give us any indication of whether or not he will have learning difficulties or development issues due to the cocaine when he reaches school age? I am curious whether there is any research showing that a lack of symptoms at a young age following prenatal exposure indicates fewer symptoms at an older age. 

Resources:

• FASD United
• Pregnancy and Breastfeeding Exposures
• Raising a Child with Prenatal Substance Exposure
• Prenatal Substance Exposure Training for Foster, Adoptive, and Kinship Parents

Transcript

Tracy Whitney 0:01

Hi, and welcome to Weekend Wisdom. My name is Tracy Whitney. I am the content director here at Creating a Family, and I am your host for today's episode. We have a slightly different twist on Weekend Wisdom today because I am joined by our resident education expert, Sarah Erdman. As the content and training developer here at Creating a Family, she specializes in resource and training that support families and children affected by prenatal substance exposure. She's trained in the Facets Neurobehavioral Model and she frequently presents on this topic and helps develop practical strategies for caregivers and professionals alike. As a former foster parent, she brings both professional expertise and lived experience to her work and especially enjoys connecting with parents and families through the parent workshops that Creating a Family offers. Before she joined Creating a Family, Sarah spent more than 30 years in public school teaching, and so we know that she knows her stuff. So welcome Sarah. We're so glad to have you. Thanks, Tracy. Nice to be here. So our question came from an anonymous listener, and I'm going to read it now and then we'll let Sarah dig into it. Our adopted son is almost four months old and perfectly healthy. He eats well, he sleeps well, and he seems to be hitting all of his milestones just fine. We know that he was exposed to cocaine during pregnancy, but he was born only three weeks early, which is still considered full term. He had a healthy birth weight and he was not suffering from withdrawal in the hospital. And he has checked out as perfectly healthy at all of his pediatrician visits thus far. My question is, does the lack of negative effects of cocaine in these early months of his life give us any indication of whether or not he will have learning difficulties or developmental issues due to the cocaine when he reaches school age? I'm curious if there's any research that shows that a lack of symptoms at a young age from prenatal exposure would indicate a lack of or less degree of symptoms for prenatal exposure at an early age. Thank you so much for everything you do. I really enjoy listening to your podcast. Over the last year and a half, I've learned so much, and it's been very helpful in preparing for adoption. So, anonymous listener, thank you for writing in and asking this big question. And I'm gonna let Sarah go ahead and share what she knows.

SPEAKER_01 2:28

Yeah, thanks, Tracy. And thank you so much to this listener for this question. And first of all, we are so glad that your baby is thriving. Those are really precious months. That's a really precious time in your family's life. So I'm glad your baby's thriving and that you're able to enjoy that precious time. I also want to thank you for not only continuing to listen to our podcast, but just um in general being curious and being curious about your baby, about your child, because uh that curiosity can lead to learning more about your child's unique makeup and how best to parent them throughout their lives, not just those months of during infancy. I do want to remind everyone that we are not mental health or medical professionals, and parents who have specific questions and concerns about their child's health and development really should be consulting their pediatrician. I will say that in the area of prenatal substance exposure, there's a good bit of inconsistency among medical professionals in their knowledge and their experience in this area. So you could ask two different pediatricians about your concerns and get two different answers. So you might want to consider seeking out a developmental pediatrician or a specialist in the area of prenatal substance exposure to provide more information. A great resource for a list of specialists and supportive organizations for children who have been prenatally exposed, regardless of the substance to which they're exposed, is to refer to the FASD United.org website, and they have a state-by-state resource directory of services and organizations in your local area that can help, including diagnostic clinics. So that being said, we do base our responses on extensive research and by talking with experts and professionals in this field, as well as the many parents that we work with in our workshops who have experience with children with prenatal substance exposure. So before I get to an answer, I'm going to provide a whole bunch of context because I think it's really important and there's not a simple answer when it comes to questions like this. So, in general, studies have found that in the US, there are between 10 and 11% of all children in our country who are born exposed to some substance or substances to some degree, 10 to 11%. Alcohol is at the top of the list, just behind tobacco in substance exposure. We also know through research that our children who are or have been involved with the child welfare system, are at a significantly higher risk of some type of substance exposure. Several experts estimate that between 50 and 80 percent of kids involved in the child welfare system have had some type and some degree of exposure. So we want our audience to know that as well. So while cocaine use, which is what this question refers to during pregnancy, is not as prevalent as some of the other substances, it doesn't make it any less concerning when you're a parent with a child that you know has had that exposure. So I am going to talk specifically about prenatal cocaine exposure. It should be noted that just like all substance exposures, there are a variety of independent factors that contribute to either the presence of symptoms or the severity of the symptoms and impacts. So associated with cocaine exposure, these factors might include the amount and timing of the exposure, any other substances that that child may have been exposed to in utero, things like maternal nutrition, maternal stress, the prenatal care that the mother received. All can figure into how it impacts the child, as well as genetics and the child's unique makeup. There are even multiple studies that have been conducted on twins who have had prenatal substance exposure. Obviously, they were exposed to the exact same substance, the same degree, the same amount, the same timing, yet they exhibit different symptoms and different degrees of those symptoms. So there's really no one size fits all answer to predicting long-term outcomes. The effects of cocaine use during pregnancy can include things like an increased risk of miscarriage, preterm birth. This listener mentioned that their baby was born three weeks premature, an increased risk of placental abruption, and impaired fetal growth. In newborns, it can cause, it can cause, doesn't mean it does always cause, but it can cause temporary symptoms, which are sometimes referred to as withdrawal. These symptoms in newborns with exposure to cocaine can include irritability, tremors, muscle stiffness. I've heard parents tell me how strong their baby is, but it could be that they have that muscle rigidity or muscle stiffness. Poor feeding, trouble with sleeping, and hyperactivity at birth. Less common are symptoms such as vomiting, diarrhea, and seizures. And these can start between a day or two after birth and can continue for weeks or sometimes even longer. But it's important to note that not all babies that have been exposed will have those symptoms. I also want to let our listeners know that any baby that had substance exposure in utero is at a higher risk of sudden infant death syndrome or SIDS. So super important to be aware of that and always put baby to sleep on their backs. However, let's move past infancy because the listener who submitted this question has a child who's past that stage. So I hope you'll keep listening. Cocaine interacts with brain receptors, and so it can alter the physical structure of the brain and survival in the neurons of the brain. This can lead to long-term learning and behavior problems, and some of these might not be seen until the child is older. Often we see kids with prenatal substance exposure who were thriving as babies and did all right as toddlers. And then when they begin school, suddenly these symptoms ramp up. Because there are many symptoms related to behavior and learning that we don't see until the demands of attending school are placed upon children. Some experts refer to these as sleeper symptoms. So even though that baby looked like they were doing just fine, suddenly we begin to see symptoms later in life. And I don't want to scare any of our listeners. It is not a must or is not a will happen. It's just the potential. It can happen. So I want to make sure that that people know that as well. And then one other piece of this puzzle that I think we need to consider is polysubstance exposure. So any individual who has had known exposure to one substance is at a higher risk for exposure to other substances. In one study, 42% of the pregnant survey respondents who reported drinking in the previous 12 months had also used at least one other substance during that same period. The most common were tobacco, marijuana, and opioids. So substance use, including among pregnant people, is underreported. So just because a child does not have a diagnosis or show symptoms at birth, or the mother did not report, does not mean they were not exposed. So none of this information, again, is intended to frighten our listeners, but we certainly want to raise awareness for the potential long-term effects of prenatal exposure to any substance so that you can be better prepared should those symptoms occur. And I really think that the bottom line is not so much focusing primarily on the specific substance that the child was exposed to, but rather to put our energy and our focus on being curious, observing our child, looking at their unique symptoms, perhaps their unique skill deficits, needs, and challenges, and then focusing on how best to support them. So again, observing your child, looking beyond surface behaviors, reflecting on are there some underlying brain differences or underlying causes contributing to those behaviors, and then finding the most loving and compassionate way to support them. So there are several ways that parents can get this knowledge to prepare themselves for the potential symptoms of any type of substance exposure. A great place to start, of course, is the prenatal substance exposure workshop for parents that creating a family provides throughout the year. Tracy mentioned it earlier. I'm sure that we'll be putting a link to more information in the show notes. It is an interactive four-part series, and it provides not only information about prenatal substance exposure, some of the same things I've been talking about today, but it also provides practical strategies to address whatever challenges might arise and the opportunity to connect with other parents and caregivers with similar experiences. So it's really special because it's it's part information and it's part support. Another great resource is to use the Creating a Family website and use the search tool. If you type in prenatal exposure, you'll be able to access a robust collection of resources about this topic. And then one other website that I think is really great for learning more about the effects of the use of various substances, including cocaine, not only during pregnancy, but also during breastfeeding, is the website mothertobaby.org. So that's another great resource. But I want to make sure that we leave you with some strategies and tips that you can take away today. So here are just a few general strategies for any child that has had any type of substance exposure in utero. First of all, the importance of using routine and consistency. And this is something that in those infant months can begin with having a routine sleep schedule, having routine and consistency in the number of caregivers. So rather than passing the baby from one family member to another, really having that one caregiver bond with the baby and be the consistent source of soothing and comfort for that child. As the child gets older, using schedules, routines, even providing visuals for those schedules to help keep that child on track and to make life predictable and feel safe for them. It can also really help make transitions easier. The second general strategy would just be a reminder to parent the child in front of you. So often our kids who have had this exposure will have gaps in their development and their chronological age may not match their developmental age. So you may have a six-year-old who socially behaves more like a typical two or three-year-old. And that's okay. So just uh adjusting your expectations based on what you see as the developmental age of your child, not just their chronological age. And this might mean that you adjust your expectations and you might need to adjust your parenting strategies as well. And we always have lots of ideas for parenting strategies here at creating a family. And then finally, in general, just a reminder that it's all about the brain. Prenatal substance exposure, regardless of the substance, can alter the physical structure of the brain. And these brain differences often show up as behavioral differences. So it's not that a child won't do what's being asked of them. Often it may be that they can't do what's being asked of them because of those brain differences. So I just want to close by again thanking you for this question and thanking you for your curiosity and wishing you the very best of luck and hoping that that beautiful, precious baby continues to thrive. But I do also want to thank you for what you're doing. The CDC has identified four protective factors that can minimize the effects of prenatal substance exposure. And you're already doing and providing the very most important one of all, and that's by providing a stable, nurturing home environment for your child. So thank you for that.

Tracy Whitney 16:19

Well, thank you, Sarah. We deeply appreciate your wisdom and expertise for this new mom. I think we can all look back on those early years of being a brand new parent and the questions and the concerns and the temptation to look super far forward when you're just trying to get through the day. And I appreciate that your wisdom that you brought here today was a really good balance of both deal with what you got today right in front of you, and then here's some things to think about for the future. So I hope this is helpful to this uh listener who wrote in anonymously. So, listeners, we hope that you also found this information helpful. It's always helpful to know you aren't alone when we're asking these big questions about parenting and prenatal exposure. So, if you know someone who is raising a child that may have had some sort of prenatal exposure, or if they're preparing for an adoption, and that is one of the considerations that they need to think about, please pass this episode on to them. Share it with them, let them know that you're with them in the journey and that they're not alone in the questions that they have to ask and the ways they have to prepare for this child. Thanks so much for listening, and we will catch you next week.