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EPSDT Care for Kids Newsletter

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Winter 2009

Care for Children Exposed to Illicit Drugs

Resmiye Oral, MD, Assistant Professor of Clinical Pediatrics
Director, Child Protection Program, University of Iowa Hospitals and Clinics
 http://www.uihealthcare.com/childprotection/
 

Nationwide, research tells us, about 6% of women use illicit drugs during pregnancy. Studies at urban teaching hospitals find that drug use during pregnancy occurs in from 10-45% of all births. Of women who stop using illicit drugs during pregnancy, the majority relapse shortly after delivery.

Here in Iowa, the Alliance for Drug Endangered Children (DEC) reports that in 2005, 1,354 Iowa children tested positive for illicit substances. Research in Johnson County, Iowa, in 2003 found parental use of illicit drugs to be a predisposing factor for two-thirds of child abuse involving denial of critical care; in areas of Iowa where drug abuse is more prevalent, this figure may reach 70-80%.

Drawing of a toddler

Perinatal exposure to illicit drugs is linked to significant medical, social, and psychological consequences. Without early intervention, infants often fall victim to further drug exposure, child abuse and neglect, and domestic violence. It is clearly important to recognize the impact of illicit drugs on children, and to  implement services for both children and families in homes where illicit drug use occurs.

In 2003, the U.S. Department of Justice created the National Alliance for Drug Endangered Children (DEC). A year later, the Iowa DEC Alliance was formed, and began working to create local DEC Teams to assist communities to address the needs of children exposed to drugs. Today, there are 18 DEC teams throughout Iowa, helping communities develop interdisciplinary, interagency collaboration to protect children from drug exposure, and to identify and provide services to children who have already been exposed. Health care providers play a key role in this process.

The National DEC Alliance has developed guidelines for the care of children who have been exposed to illicit drugs, and these guidelines are being implemented in Iowa by local DEC teams.

Drawing of a toddler getting into a wastebasket

LEVEL I CARE should be provided to children found in environments where meth is manufactured:
Children found in homes where meth labs exist are in danger of burns from flash-fires and explosions. They are also endangered by the toxic chemicals used to make meth.

Breathing the air and touching surfaces in a home that is a meth lab can expose a child to these toxins. Drug manufacturing environments may also contain weapons and pornography, increasing the risk of injury or abuse. Level 1 care should be provided when a child’s acute exposure to illicit drugs is documented.

LEVEL II CARE should be provided to children endangered by parental substance abuse:
Children whose parents abuse drugs often face neglect and physical abuse. These children frequently live in the midst of chaos, without health care or parental supervision. Level 2 care should be provided when past or chronic exposure to illicit drugs is documented. It should also be provided when urine and hair tests come back negative, but clear evidence exists that the child’s caregivers possess, use, or sell illegal drugs in the child’s home or its vicinity.

Health care for children exposed to illicit drugs, whether at Level 1 or Level 2, includes:

  • Medical evaluation and treatment
  • Submission of a urine sample for illicit drug testing to explore acute exposure
  • Submission of a hair sample, to explore past or chronic exposure

Even if no exposure is documented or suspected, it is still important to establish a medical home for the child, who should be examined within the week.

More detailed information about Level 1 and Level 2 care.

References

Frohna JG et al. Maternal substance abuse and infant health: Policy options. Millbank Q 1999.

Hohman MM et al. A comparison of pregnant women presenting for alcohol and other drug treatment. Child Abuse Negl 2003.

Iowa Drug Endangered Children (DEC) Alliance

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