International Adoption Book

Saturday, October 4, 2008

"Drugs Don't Hurt Anybody"

For years I've heard the phrase "Drugs don't hurt anybody but the user" and for years I've heard all the arguments in support of and against this ideal. Most people tend to passionately advocate one way or another, but few are advocating out of experience. An amazingly small amount of people are truly aware of the effects prenatal drug exposure has on infants, toddlers and school aged children. It is my hope that this post will give you a more clear picture of exactly what happens to a child who has been prenatally exposed to Crystal Meth and how much they actually have to overcome during their young lives. As you read this, bear in mind that many adoptive and/or foster parents regularly (and very willingly) handle the numerous symptoms that are listed below. Both the child and the parents deserve to know that they are not alone; there are others just like them out there and there is support. The following is my way of educating others and giving my support to the families who fight this exposure every day: Keep up the amazing work... You're children deserve the chance you are giving to them! (What follows was copied from this site.)

Pre-Natal Meth Exposure

I was clean from meth for 6 months and started using again. I am now 7 months pregnant what can this do to my baby?

Alice's Answer: Methamphetamine use during pregnancy is believed to place the unborn fetus at risk. Methamphetamine causes increased maternal blood pressure and heart rate, which can result in premature delivery or spontaneous abortion. The drug also constricts blood vessels in the placenta that feed the fetus which results in reduced blood flow to the fetus and ultimately reduced oxygen and nutrient supply. It is known that methamphetamine passes through the placenta that feeds the fetus and can cause elevated fetal blood pressure potential leading to prenatal strokes, heart or other major organ damage. It can also cause an increased or extremely variable heart rate in the fetus and slowing or alteration of fetal growth.

Fetal development abnormalities have been described sporadically in the medical literature but no true syndrome specifically linked with maternal use of methamphetamine use in the prenatal period has been described. Fetuses exposed in utero have been shown to have central nervous system abnormalities, cardiovascular system abnormalities, intestinal abnormalities, urogenital system abnormalities, and malformations of the extremities. However, though these results are very suspicious and highly suggestive of the involvement of methamphetamine use, the direct link between fetal abnormalities and maternal methamphetamine use is not clearly discernable.
With the exception of any major organ system damage or permanent vessel damage, birth outcomes are felt to improve if the mother stops using the drug in the last 6 months of the pregnancy.

The full effect of maternal use of methamphetamine on the newborn infant is not completely known and there is currently a multi-center study underway to better describe this issue. It is, however, known that the infant may suffer intrauterine growth delay and is usually smaller than the norm at birth. Some of these infants have withdrawal symptoms and a recent study showed that about 4% of that study of methamphetamine-exposed infants needed treatment for withdrawal. Newborns that were exposed to methamphetamine in utero are frequently very sleepy for the first few weeks after birth, often to the point on not waking to feed. After this time, the infants behave more like a cocaine-exposed infant and are often jittery, irritable and have a shrill cry. Infants may have irregular sleep patterns, poor feeding, tremors and increased muscle tone. These infants may also have a poor ability to habituate or self-regulate, especially under stressful situations. Therefore, if their environment is noisy and chaotic, the infants do not tolerate it well and can become even more irritable.

Finally, these infants are known to be at increased risk for SIDS, viral hepatitis (such as Hepatitis B and C), and HIV.

What are the possible areas of concern for children who may have been exposed to meth in the womb, and after they are born?

Health Conditions of Drug-exposed Infants

Birth weight: Birth weight is an important factor associated with children's overall health and development. Children who weigh under five-and-one-half pounds at birth are more likely to have serious medical problems and to exhibit developmental delays. Drug-exposed infants often do not exhibit normal development.

Prematurity: The risk of prematurity (birth at less than thirty-seven weeks) is higher in drug-exposed infants. Other complications can include an increase in acute medical problems following birth, and extended periods of hospitalization. Birth weight under three pounds has been associated with poor physical growth and poor general health status at school age. Low Birth weight infants also have an increased risk of neurosensory deficits, behavioral and attention deficits, psychiatric problems, and poor school performance. Premature infants may have experienced bleeding of the brain tissue, hydrocephalus, bronchial problems, eye disease, and interferences with the normal ability to feed.

Small for Gestational Age (SGA): This term is used to describe infants whose Birth weight is below the third percentile for their gestational age (i.e., 97% of infants the same age are heavier than the SGA infant). It is common for women who abuse cocaine to experience decreased appetite and provide inadequate nutrition for themselves and their baby.

Failure to Thrive (FTT): Infants who were exposed to alcohol and/or drugs may exhibit this disorder, which is characterized by a loss of weight, or slowing of weight gain, and a failure to reach developmental milestones. This can be due to medical and/or environmental factors. The infant's behavior includes poor sucking, difficulty in swallowing, and distractibility. Many of these children live in chronically dysfunctional families which places them at greater risk of parental neglect.

Neurobehavioral symptoms: Within seventy-two hours after birth, many infants who were exposed prenatally to drugs experience withdrawal symptoms, including tremors and irritability. Their skin may be red and dry; they may have a fever, sweating, diarrhea, excessive vomiting, and even seizures. Such infants may require medication for calming. Other infants exposed to stimulants show a pattern of lethargy during the first few days after birth, are easily overstimulated, and may go from sleep to loud crying within seconds. These behaviors usually decrease over time and subside in toddlerhood.

Infectious diseases: Infants with prenatal drug exposure may be exposed prenatally or postnatally to infectious and/or sexually transmitted diseases contracted by their mothers. The most common infectious diseases seen in infants are chlamydia, syphilis, gonorrhea, hepatitis B, HIV, and AIDS.

Sudden Infant Death Syndrome (SIDS): Children who have been exposed prenatally to alcohol and/or drugs have an increased risk of dying from sudden infant death syndrome. The causes of SIDS are unknown and its occurrence is almost impossible to predict. Apnea/cardiac monitoring is recommended for these infants.

Fetal Alcohol Syndrome: Mothers who consume large quantities of alcohol during pregnancy may have babies who are born with Fetal Alcohol Syndrome (or FAS). A diagnosis of FAS is based on three factors: 1) prenatal and postnatal growth retardation; 2) central nervous system abnormalities, and, 3) abnormalities of the face. Many of these children display significant disabilities, learning disorders, and emotional problems as they mature.

Each of the above conditions associated with prematurity or drug exposure has programmatic implications for caregivers; the children who exhibit these conditions are often referred to as medically fragile.

Developmental Outcomes: There are many unknowns involved in trying to predict the outcomes of infants and children exposed to drugs. While we know that there are certain physical problems that may remain with the child, in a structured and nurturing environment, many of these children are able to grow and develop quite normally. A small percentage of children have been found to have moderate to severe developmental problems. But regardless of their health status, all children who have a history of prenatal substance exposure should receive developmental evaluations on a regular basis: at least once during the first six months; at twelve months; and at least every year thereafter until school age. Early identification of social, language, cognitive and motor development problems is essential.

Developmental Patterns in Children Exposed Prenatally to Drugs

Birth to fifteen months: Unpredictable sleeping patterns, Feeding difficulties Irritability, Atypical social interactions, Delayed language development, Poor fine motor development.

Toddlers from sixteen months to thirty-six months: Atypical social interactions, Minimal play strategies.

Preschool children from age three to five: While average preschoolers are beginning to share and take turns, demonstrate language skills, and increase their attention spans in a group setting, the drug-exposed toddler may be hyperactive, have a short attention span, lose control easily, have mood swings and problems moving from one activity to another. These children may also experience difficulties processing auditory or visual information/instructions.

School and teenage years: There has not been sufficient research into the long term biological effects of drug exposure on older children and teenagers; however, we do know that children with the behaviors described above are at greater risk of abuse and neglect, learning disabilities, and behavioral problems. Obviously, it becomes imperative to identify these problems at a very early age, access the necessary resources for the child, and build a team of professionals who regularly monitor the progress of each child.

Supporting a drug-exposed child in the course of his life may require advocating vigorously for specialized educational services; providing recreational and employment opportunities that allow a measure of success; educating parents; and providing counseling.

Techniques in Working with Drug-exposed Infants and Young Children:

Respite and crisis care programs working with drug exposed infants and children may not know the exact drugs to which each child was exposed. A combination of substances, including alcohol and tobacco, may be involved.

There are a few techniques, however, which can be used in a general plan of care that may be individualized to meet the specific problems of each child:
Provide a calm environment: low lighting; soft voices; slow transition from one activity to another.
2. Be aware of signs of escalated behavior and frantic distress states before they occur, e.g., increased yawns, hiccoughs, sneezes, increased muscle tone and flailing, irritability, disorganized sucking, and crying.

Use calming and special care techniques on a regular basis, such as:
swaddling blankets tightly around the infant.
2. sing a pacifier even when the infant is not organized enough to maintain a regular suck.
3. rocking, holding, or placing the infant in a swing, or Snuggly™ carrier.
4. massaging the child.
5. bathing in a warm bath, followed by a soothing application of lotion.
6. rubbing ointment on diaper area to prevent skin breakdown.
7. encourage developmental abilities when the infant is calm and receptive using only one stimulus at a time. Look for signs of infant distress and discontinue the activity if this occurs.
8. gradually increase the amount and time of daily developmental activities; encourage the child to develop self-calming behaviors and self control of his own body movements.

Behavior Descriptions and Suggested Strategies.

Feeding problems: Feed the baby more often; feed smaller amounts at one time; allow the infant to rest frequently during feeding. Place the infant upright for feeding; after feeding, place the child on his side or stomach to prevent choking; if vomiting occurs, clean the skin immediately to prevent irritation.

Irritability/unresponsive to caregiver: Reduce noise in the environment; turn down lights; swaddle the infant: wrap snugly in a blanket with arms bound close to the body. Hold the infant closely; put the infant in a bunting-type wrapper and carry it close to your body. Rock the infant slowly and rhythmically, either horizontally or with its head supported vertically, whichever soothes. Place the child in a front-pack carrier; walk with the infant; offer the infant a pacifier or place it in an infant swing.

Goes from one adult to another, showing no preference for a particular adult: Respond to specific needs of child with predictability and regularity.

May have poor inner controls/frequent temper tantrums: Use books, pictures, doll play, and conversation to help the child explore and express a range of feelings.

Ignores verbal/gestural limit setting: Talk the child through to the consequence of the action.

Shows decreased compliance with simple, routine commands: Provide the child with explicitly consistent limits of behavior.

Exhibits tremors when stacking or reaching: Observe the child and note the onset of tremors, their duration, and how the child compensates for them; provide a variety of materials to enhance development and refinement of small motor skills, e.g., blocks, stacking toys, large Leggos™, and puzzles with large pieces. Sand and water play are soothing and appropriate.

Unable to end or let go of preferred object or activity: Provide attention and time to children who are behaving appropriately; provide child with an opportunity to take turns with peers and adults.

Delayed receptive and expressive language: Create a stable environment where the child feels safe to express feelings, wants, and needs; use stories/records/songs; use hands-on activities to reinforce the child’s language abilities.

Expresses wants, needs, and fears by having frequent temper tantrums: Remove and help calm the child; redirect the child’s attention; verbalize the expected behavior; reflect the child’s feelings. Praise attempts toward adaptive behavior. Set consistent limits.

Difficulty with gross motor skills (e.g. swinging, climbing, throwing, catching, jumping, running, and balancing): Provide appropriate motor activities through play, songs, and equipment. Offer guidance, modeling, and verbal cues as needed.

Over-reacts to separation of primary caregiver: Offer verbal reassurance; be consistent, and help the child learn to trust adults.

Withdraws and seems to daydream or not be there: Provide opportunities for contact; move close to the child, make eye contact, use verbal reassurance; allow, identify, and react to the child’s expressions of emotions.

Frequent temper tantrums: Understand that a tantrum is usually a healthy release of rage and frustration; protect the child from harm; remove objects from the child’s path if he is rolling on floor. Some children do not want to be held during a tantrum and doing so can cause more frustration. Remain calm, using a soothing voice; anger will only escalate the child’s frustration. Do not shout or threaten to spank the child–the adult needs to be in control. Help the child to use words to describe emotions. Read stories about feelings. Help the child gain control by making eye contact, sitting next to the child, giving verbal reassurance, and offering physical comfort (rubbing back, etc.). Note the circumstances that provoked the tantrum, and try to avoid such confrontations when possible. Provide a neutral area for the child to work through the tantrum, (e.g., a large cushion or bean bag chair). Some children want to work through a tantrum alone; keep the child in sight, but do not interact until he is calm.

Parent Involvement.

It is critical to the success of the drug-exposed infant that the eventual caregiver (parent, relative, foster parent, respite provider, adoptive parent) learn the care routine, control techniques, and background of the children for whom they will be providing care. Understanding the etiology of drug-exposure, the types of medical problems that arise, the developmental patterns, and the techniques for handling drug-exposed infants and toddlers is imperative.

Program social workers, case managers, child care staff, and nursing staff must all work together with the caregiver to offer parent education (“hands-on” opportunities to provide care under the guidance of professionals), and encouragement for families who undertake the care of a drug-exposed infant. The caregiver’s understanding of the child’s behavior, physical “cues,” and developmental problems, goes a long way in helping the drug-exposed infant, toddler, and teen succeed. It also assists the caregiver in setting realistic expectations for children who enter the world battling the effects of their parent’s addiction. Many children who were prenatally exposed to drugs will grow and develop without unusual problems. However, for those infants who have physical indicators, the respite and crisis care provider can make a difference by providing, perhaps, the first stable, nurturing environment. Here, the child can be observed, positive routines for care can be established, and parents can receive the critically necessary education and support to enable them to care for an alcohol or drug-exposed child.

Summary: Staff training, caregiver training, and parent education are all critical elements of any program that will be successful with these children. Physical elements of the environment (lighting, noise, and space) may need to be adjusted to accommodate their care. The inclusion of medical support, i.e., nurses and physicians who are familiar with the problems of these children, is essential. In summary, the care of alcohol and drug-exposed children is a team effort that requires coordination, case management, special care techniques, and education to be successful in any respite or crisis care situation. With these components in place, agencies and families can witness the positive growth and development of children who have been greatly at risk.


blessedmomto7 said...

May I quote your "DRUGS DON"T HURT ANYONE" blog post at my conference? I think it is very powerful! I leave today-pray for me and wish me luck!

Manette said...

Jen, please feel free to quote my blog. The first paragraph is the only part that is mine, though. The informational section is a direct quote from this link.

This is a huge step for all the innocent children affected by prenatal drug use. I will keep you in my thoughts and prayers during this special, demanding and amazing week.

PS... Feel free to email me anytime at