|Children with Prenatal
Drug and/or Alcohol Exposure
This factsheet is available
The drug epidemic that swept this country during the 1980’s has had a devastating effect on families, and particularly on the children who have been the silent victims of prenatal exposure to drugs. The number of children born each year exposed to drugs and/or alcohol is estimated to be between 550,000 and 750,000. In addition to the biological risk that prenatal alcohol or drug exposure poses to these children, they are at an increased risk of child abuse and neglect by parents whose need for drugs takes priority over the care of their infants and children. As a result of these factors, there has been a sharp increase in the number of drug exposed children in out-of-home placements, including respite and crisis care programs.
Health Conditions of Drug-exposed Infants
Small for Gestational Age
Failure to Thrive (FTT)
Sudden Infant Death
Fetal Alcohol Syndrome
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".
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.
Birth to fifteen months
Toddlers from sixteen months to thirty-six months
Preschool children from
age three to five
School and teenage years
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.
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:
Behavior Descriptions and Suggested Strategies
Goes from one adult to
another, showing no preference for a particular adult
May have poor inner
controls/frequent temper tantrums
compliance with simple, routine commands
Exhibits tremors when
stacking or reaching
Unable to end or let go
of preferred object or activity
Delayed receptive and
Expresses wants, needs,
and fears by having frequent temper tantrums
Difficulty with gross
motor skills (e.g. swinging, climbing, throwing, catching, jumping,
running, and balancing)
Over-reacts to separation
of primary caregiver
Withdraws and seems to
daydream or not be there
Frequent temper tantrums
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 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.
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.
About the Author: Jeanne Landdeck-Sisco, MSW, is the Executive Director of Casa de los Niños in Tucson, Arizona, which was the first crisis nursery in the U.S., established in 1973. Ms. Landdeck-Sisco served as the first President of the ARCH National Advisory Committee for Respite and Crisis Care Programs from 1991-93 and remained on the committee until 1996.
Center for Substance Abuse Prevention National Resource Center for the Prevention of Perinatal Abuse of Alcohol and Other Drugs, 9302 Lee Highway, Fairfax, VA 22031, (800) 354-8824.
National Organization on Fetal Alcohol Syndrome, 1815 H Street, N.W., Suite 710, Washington, DC 20006, (202) 785-4585.
Besharov, Douglas J. When Drug Addicts Have Children. Washington, DC: Child Welfare League of America, 1994.
Hargrove, Elisabeth, et al. Resources Related to Children and Their Families Affected by Alcohol and Other Drugs. Chapel Hill, NC: NEC*TAS, 1995.
Special acknowledgment is given to Rosemarie Dyer, R.N., Nursing Supervisor at Casa de los Niños, who has developed the agency’s program for drug- and alcohol-exposed infants and from whose training material many of the techniques and caregiver responses have been drawn; and to Anna Binkiewicz, M.D., Casa de los Niños Board Member and Medical Director, who has provided on-site medical treatment of Casa’s medically fragile children.
ARCH Factsheet Number 49, April, 1997
|This factsheet was produced by the ARCH National Resource Center for Respite and Crisis Care Services funded by the U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau—Cooperative Agreement No. 90-CN-0178 under contract with the North Carolina Department of Human Resources, Division of Mental Health/Developmental Disabilities/Substance Abuse Services, Child and Family Services Branch, Raleigh, North Carolina. The contents of this publication do not necessarily reflect the views or policies of the funders, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Department of Health and Human Services. This information is in the public domain. Readers are encouraged to copy and share it, but please credit the ARCH National Resource Center.|