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Winter
2009 |
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Guidelines for the Care of
Children Exposed to Illicit Drugs
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Easy-print
PDF |
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LEVEL 1 CARE - Onsite
Medical Assessment
For a child found in
an environment where meth is manufactured |
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ONSITE MEDICAL ASSESSMENT
should be carried out in the field:
- Within 2 hours of discovering the child
- By medical personnel (such as EMT, PNP, PHN)
- To determine if the child requires emergency medical care
FIRST STEPS
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If child seems affected or ill, call
911; transport to ER
immediately
if child’s life is at risk |
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Transport to local ER within 2 hours:
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Assess vital signs: Temperature,
blood pressure, pulse, respiration |
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Assess pediatric triangle:
Airway, breathing, circulation |
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Remove child’s clothing
and bathe child on site if possible, then dress in clean
clothing. Leave contaminated clothing, toys, etc. on
site for collection by law enforcement as evidence | |
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LEVEL 1 CARE - Emergency Room
Medical Assessment
for child presenting in the ER with significant
health concerns |
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BASELINE
ASSESSMENT
Carry out
within
2 hours of discovering child:
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Assess vital signs and pediatric triangle
if not done in the field |
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Decontaminate the child with shower, soap
and water, new clothes if not done in the field; bag
contaminated clothing and give to law enforcement |
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Collect urine sample for toxicology screening
within 12 hours. Request report of any detectable
levels. Obtaining urine sample is a key goal
of emergency exam; follow “chain of evidence” procedure:
- Document
in writing every transfer of evidence from one person
to another
- Transfer
as little as possible
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Be sure no one other than those documented
can access evidence -
If
law enforcement brought child to ER, urine sample may
be collected and given to officer for testing |
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Perform
comprehensive physical exam (including neurologic, respiratory,
skin, affect) |
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Obtain child’s medical history from
parents or case worker
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Additional
tests to order:
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Liver
function (AST, ALT, total bilirubin, Alk Phos) |
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Kidney
function (BUN, creatinine) |
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Electrolytes,
CBC |
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Lead
level |
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Urinalysis
and urine dipstick for blood | |
If
respiratory distress,
consider ordering:
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Oxygen
saturation test |
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Carboxyhemoglobin
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Chest
x-ray |
If severely battered:
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Comprehensive
metabolic panel (Chem 20 or equivalent) |
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Creatine phosphokinase (CPK) |
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Coagulation
studies (if bleeding) |
If
parents use IV drugs,
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Call Poison Control
Center if clinically indicated: 1-800-222-1222 | CHILD
ABUSE EVALUATION
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Skeletal
survey for child <2 years old |
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Ophthalmology
exam for child <1 year old |
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Head
CT/MRI if eye or neurologic exam is abnormal, or child
is <1 year of age and you find other signs of abuse
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Screen
for sexually transmitted diseases |
| | Collect
forensic evidence (using chain of evidence procedure)
when
- Genital
exam is abnormal and child is non-verbal, or
- Child
discloses sexual abuse
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Schedule
initial follow-up exam
with Early ACCESS, Child Protection Center, or child’s
medical home within 30 days of ER visit |
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Secure
necessary releases for child’s medical records |
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LEVEL 1 CARE: Follow-up |
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INITIAL FOLLOW-UP CARE
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Provide follow-up
within 30 days of baseline assessment |
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Review labs done in the ER; order any missing tests |
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Administer first doses of missing immunizations
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Consider:
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Hepatitis
screening if liver function tests abnormal |
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Tuberculosis
screening if risk factors |
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Nutritional
consult if failure to thrive
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Complete physical exam (including
neurologic, respiratory, skin, and affect) |
Refer:
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For full developmental, behavioral, emotional assessment by Early ACCESS,
AEA, Child Health Specialty Clinic, or developmental pediatrics clinic
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For dental care |
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To establish medical home
for long-term care
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LONG-TERM FOLLOW-UP CARE
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Begin 6-12 months after
baseline assessment |
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Provide
comprehensive physical exam with special attention to
previous findings
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Repeat abnormal lab tests
until normal
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Monitor release of
previous medical records
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Complete missing
immunizations and screenings |
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Establish age-appropriate maintenance visits
after everything normalizes |
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Monitor for emotional
problems (attachment disorder), behavioral problems
(chronic irritability, ADHD, conduct disorder, poor
social skills) | 
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LEVEL
2 CARE
For children
exposed perinatally or postnatally
but not via
meth lab exposure |
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CARE FOR NEWBORN
EXPOSED IN UTERO
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Send urine and
meconium sample for illicit drug testing as soon after delivery as
possible |
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Perform structured
assessment for physical problems: |
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Neonatal abstinence
syndrome or withdrawal symptoms |
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Congenital anomalies |
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Growth retardation
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During well-child
health care visits, monitor for emotional (attachment disorder) and
behavioral concerns, (chronic irritability, ADHD, conduct disorder, poor
social skills) |
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Treatment plan should
include referral to Early ACCESS, AEA, Child Health Specialty Clinic, or
developmental pediatrics clinic to address concerns with development,
behavior, mental or emotional health | |
CARE FOR CHILD
EXPOSED POSTNATALLY
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Provide comprehensive
medical evaluation as soon as possible after removal from caregiver |
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Send urine sample to be
tested for illicit drugs, to explore acute exposure |
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If acute exposure is
documented, follow the protocol for Level 1 children, above |
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If acute exposure is not
found, establish a medical home for the child, and refer for examination
within a week |
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Send hair sample to
be tested for illicit drugs to explore chronic or past exposure. If
positive, follow the Level 1 initial and ongoing follow-up protocols
above |
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Regardless of urine and
hair test results, if clear evidence exists that caretakers posses, use,
or sell illegal drugs in the home or its vicinity, the child should
receive Level 1 care, including follow-up | | |
