The Youngest Victims- Addressing the Need of Substance Exposed Infants

In November 2016, in response to the significant increase in deaths due to opioid overdose, Governor Terry McAuliffe and Virginia Health Commissioner Marissa Levine declared a public emergency over the state’s opioid addiction crisis. The following are some staggering facts regarding this epidemic:
• Emergency Room visits in Virginia due to drug overdose increased by 89% from 2015 to 2016.
• In Virginia, more people died in 2014 from opioid overdoses than from fatal car accidents.
• It is estimated that the rate of babies born with Neonatal Abstinence Syndrome (NAS) nearly tripled from 2000 to 2009, to a rate of 3.39 per 1000 births. ( NASD) In rural areas, between 2000-2012, the rate increased from 1.4 per 1000 births to 7.5 per 1000 births.
• The average length of hospital stay for a baby born with NAS is 23 days compared to 1-2 days for a healthy newborn. Babies born substance exposed typically remain in the hospital 5 days after birth since it may take up to 5 days for withdrawal symptoms to emerge.
• Costs associated with babies with NAS are estimated at $53,400 per birth compared to $9,500 for other births.
• Neglect due to substance abuse disorders was the second most commonly cited reason children entered foster care in 2013. ( Forecasting Neonatal Abstinence Syndrome Cases)

Neonatal abstinence syndrome (NAS) refers to a treatable condition that newborns experience after chronic exposure to certain substances, primarily opioids, while in utero (National Association of State Alcohol and Drug Abuse Director). Newborns affected by NAS may experience gastrointestinal issues, metabolic and respiratory issues, and central nervous system issues. Symptoms my include difficulty feeding, irritability, high pitched crying, difficulty with self regulation/calming, difficulty sleeping, muscle tightness, tremors, diarrhea, excessive sucking, poor feeding, seizures, frequent hiccups, and frequent yawning. Neonatal withdrawal symptoms are usually noted within 5 days after birth, symptoms can last up to 6 months after birth. When an infant is diagnosed with NAS, continued medical treatment is required in a neonatal intensive care unit.

The relationship between prenatal substance exposure and early development is complex. It’s difficult to make a direct correlation between drug use and developmental delays for a number of reasons. Factors such as poor prenatal care, the point in time during pregnancy certain drugs were used, environmental factors, and parenting all play a part in how a child develops. Developmental screenings and evaluations are recommended on a regular basis until a child reaches school age. Early identification of delays or other issues in the areas of social emotional development is essential.

In the state of Virginia, infants who are diagnosed with Neonatal Abstinence Syndrome are automatically eligible for Early Intervention services under Part C of the Individuals with Disabilities Act (IDEA). These infants may not display delays but may demonstrate symptoms that are atypical to newborns. The symptoms may also interfere with the mother or caregiver’s ability to establish a strong bond with the baby. Part C early intervention builds upon and provides supports and resources to assist family members and caregivers to enhance children’s learning and development through everyday learning opportunities.

Prenatal substance exposed infants comprise approximately 30 % of referrals to the Infant and Toddler Connection of the Shenandoah Valley (ITC-SV). Roughly another 25% of those referred are infants with a NAS diagnosis. Often, the mothers or caregivers are reluctant to accept services for fear of being judged or because they are not aware of subtle challenges a NAS baby will have compared to typical babies. The Clinical Service Coordinator of the ITC-SV, Robin Hockman, has experience working with women with substance abuse issues and children with developmental concerns. She is sometimes able to meet with families while their babies are still in the NICU to offer information and guidance while setting the groundwork for a trusting relationship. The families need to know that the role of early intervention is not to try to take away their babies, but to help them develop the skills and knowledge to address the needs of their baby.

The team of early intervention providers, including the Clinical Service Coordinator, is able to offer a range of supports and services, depending on the concerns the family may have regarding their baby. On-going service coordination is one service offered to provide monthly monitoring and guidance on typical child development. Other professional services such as physical therapy, occupational therapy, and speech therapy may work with the family to address feeding issues, sensory issues, atypical social development, motor delays and language delays. Issues and concerns related to attachment are also an area early intervention professionals may provide education and guidance to promote healthy social emotional development. They may work with the parent/caregiver to understand their baby’s cues and possible developmental problems.

The success of a baby born prenatally substance exposed is in the early identification of atypical development and/or delays. The ITC-SV staff recognizes that these parents and caregivers are facing challenges of their own while also trying to care for a baby with unique, demanding and often complicated needs. Until the issues surrounding increase drug use in pregnant women, particularly heroin, in the Shenandoah Valley are resolved, the Infant and Toddler Connection of the Shenandoah Valley will continue to meet the needs of the youngest victims of this epidemic.