Parents and caregivers of children who abuse alcohol or use, produce, or distribute drugs have kids who are at increased risk of medical and behavioral problems. A new clinical report by scientists at Beth Israel Medical Center (BIDMC) and Boston Children's Hospital says pediatricians are uniquely positioned to assess these risks and intercede to shield young people.
The new report, "Families Affected by Parental Substance Use," will be published in the August edition of the journal Pediatrics. The study is also available online.
"Alcohol misuse and substance use are exceedingly common in this country, and parents' or caregivers' substance use may affect their ability to consistently prioritize their children's basic physical and emotional needs and provide a safe, nurturing environment," says co-author Vincent C. Smith, MD, MPH, a neonatologist at BIDMC and Assistant Professor of Pediatrics at Harvard Medical School (HMS). "Because these children are at risk of suffering physical or emotional harm, pediatricians need to know how to assess a child's risk and to support the family to get the help they need."
One in five US young people grow up in families with someone who misuses alcohol or has a substance use disorder. Some suffer from exposure to the harmful elements themselves and others from parental neglect of their basic needs, and children in these households often experience educational and developmental delays. Later in their lives, these youngsters are more likely to have a higher risk for behavioral problems and mental health issues.
Children raised in these families also have a higher likelihood for substance use disorders in the future than their peers.
Smith and co-author Celeste R. Wilson, M.D., Medical Director of the Child Protection Program at Boston Children's Hospital and Assistant Professor of Pediatrics at HMS, reviewed the clinical signals of fetal alcohol, cannabis, opioids, and stimulants exposure. They say that pediatricians must be vigilant for signs of neonatal abstinence syndrome (NAS).
Prenatal opioid exposure can cause irritability, seizures, muscle stiffness, and diarrhea. Recent statistics have shown that NAS affected 22,000 babies in 2012. A separate study found that opioids were prescribed to over a quarter of expectant mothers during their pregnancies.
The authors of "Families Affected by Parental Substance Use" cited studies that discovered children in families in which parents use drugs and misuse alcohol are three times more apt to be sexually, physically, or emotionally abused and four times more likely to be neglected than their peers.
The authors strongly encourage pediatricians to question caregivers about their substance use as a part of the regular family assessment.
Warning signs of neglect or abuse include injuries and bruising on a frequent basis; withdrawn or fearful kids who flinch at sudden movements; lack of dental care or immunizations; and ill-fitting, dirty, or inappropriate clothing, writes Dr. Rick Nauert for PsychCentral.
Pediatricians have the ability to break "multigenerational cycles of abuse," explain the authors.
Dr. Smith writes in an article for the American Academy of Pediatrics that over 9.4% of US 12-year-olds and older adolescents used psychoactive substances in 2013. He lists some guidelines for pediatricians, such as screening parents for substance use and discussing options for access to treatment from their primary care physician or a specialist.
He adds that the doctors should be alert for signs of abuse or neglect in the young people they see whose families are affected by substance use.
He encourages physicians to monitor young ones for developmental delays and academic difficulties. Smith also says pediatricians should become adept at mandatory reporting requirements for suspected child neglect and abuse.