Though the opioid crisis in this country is getting more public and policymaker attention, the epidemic’s youngest victims – infants and children – are often overlooked. In BPC’s report, A Bipartisan Case for Early Childhood Development, we call on both Congress and the federal agencies to do more to ensure young children are considered as policy solutions are proposed and enacted. We also must work to guarantee that all those who care for infants exposed to substances in-utero have received the training and preparation they need to meet these children’s unique needs and support healthy development.
In recent years, an opioid epidemic has taken large swaths of the country by storm. Though no region in the country has been immune, rural and tribal communities have seen especially high levels of devastation. More than 2.1 million Americans had an opioid use disorder in 2016, and the Centers for Disease Control and Prevention (CDC) reports opioid-related deaths have more than quadrupled since 1999. Additionally, many newborns who have been exposed to opioids in-utero will experience what is called Neonatal Abstinence Syndrome (NAS). The NAS rate has increased by nearly 300 percent between 1999 and 2013. According to the National Institute on Drug Abuse, a baby suffering from opioid withdrawal is born every 25 minutes and has an average hospital stay of nearly 17 days (versus 2.1 days for a non-opioid exposed child), leading to an additional $1.5 billion in hospital costs annually.
Neonatal Abstinence Syndrome rate has increased by nearly 300 percent between 1999 and 2013.
Depending on the severity of drug withdrawal, babies with NAS are more likely to be low in birth weight, have difficulty eating and digesting and experience poor sensory integration, respiratory issues, hyperactivity, seizures, fever, lack of sleep, and uncoordinated sucking and swallowing. Many of these infants may be sensitive to touch and may be difficult to soothe, profoundly impacting bonding and attachment between parent and child. While the research on long-term impacts is inconclusive, children born with NAS appear more likely to have behavioral problems such as a poor attention span, hyperactivity, and challenges with self-regulation- each of which predict academic failure.
The costs don’t end there. Substance use disorders can lead to ineffective parenting which, in turn, has adverse effects on a child’s early development and long-term outcomes. Without support and recovery, daily life can be chaotic and unpredictable, often resulting in the failure of a parent to meet even the basic needs of children such as nutrition, supervision and nurturing. What’s more, children who have been exposed to substances in-utero may require even more support, attention, and diligence than a child who has not been. This mismatch between a child with additional needs and a parent who is unable to meet them has long-term consequences and costs.
For example, children in households where parents struggle with substance use disorders are more likely to experience long-term effects of neglect or abuse than other children. Additionally, many treatment centers do not allow parents to be with their children. As such, the foster care system is experiencing significant strain. After years of decline, the number of children in foster care has been rising steadily since 2012. The early childhood system is also under considerable strain, with providers across the country serving young children with NAS and other children who have been exposed to substances, but with little expertise, training or support.
Recognizing the overlapping needs of parent and child is important in the midst of the opioid epidemic. Studies show there are steps that can be taken to support both parents and infants affected by opioid use. For example, babies with NAS have a shorter hospital stay when they can room with their mothers. Breast-feeding, when possible for both the infant and mother, has also been shown to reduce the severity of symptoms in infants with NAS. Other non-pharmacologic treatment can include swaddling, promoting skin-to-skin contact, rocking, and frequent, small feedings. A recent GAO report focuses on the importance of these non-pharmacologic approaches in prioritizing the mother-infant bond in NAS treatment. To improve outcomes for these infants, the report calls for providing mothers with education on prenatal care, treatment for NAS, and resources for infants, while also educating health care providers on the stigma faced by woman who use opioids during pregnancy.
More can be done to address this issue. There is bipartisan support for strengthening early child development efforts, including trying new approaches to early childhood as states, communities, and families deal with the opioid crisis and other challenges. Going forward, more must be done to educate the parents, grandparents, child caregivers, and Head Start teachers who work with, teach, and care for children affected by this issue. When it comes to the opioid epidemic, both health and care providers and Congress must recognize the importance of treating the entire family.