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Babies born addicted: Neonatal Abstinence Syndrome

Sherri Kuhn writes about raising teenagers, the perils of a clean home, wistfulness over babies, and anything else that makes her laugh (or cry) in the years between changing diapers and wearing them. With a son just starting college and...

Littlest addicts have a rough start in life

Whether their mother was using illicit opioid street drugs or misusing prescription pain killers, babies born to addicted mothers all have one thing in common — they are at risk for withdrawal after delivery. What happens to these babies — and their mothers?
Baby in NICU

What are the dangers to the infant when the mother is drug dependent during pregnancy? What happens to these babies after they are born? We spoke to experts who deal with drug dependent mothers and their babies, to find out what the future holds for them.

Danger in the womb

From the moment of conception, the developing baby is susceptible to harm from being exposed to the drugs and/or alcohol in the mother’s system. As the baby develops, he can be affected by the substances his mother abuses, and the baby may suffer withdrawal symptoms. A study by Stephen Patrick, M.D., MPH, of the University of Michigan in Ann Arbor (reported online in the Journal of the American Medical Association) found that the number of mothers using opiates at the time of delivery rose five-fold during the period between 2000 and 2009. This is a problem that is affecting more and more babies each year.

Addiction in pregnancy

Fighting addiction is difficult, and not always successful. Most often intervention is necessary, under the supervision of a physician in either an outpatient or inpatient setting.

For some women, their pregnancy is the kick they needed to get clean — and stay clean. Sadly, for others the lure of their addictions is too strong, and they continue to abuse drugs or alcohol during pregnancy and after delivery.

“Many women want to get clean once they find out that they are pregnant,” shares Patricia Newell Bennett, a board certified therapist in private practice who specializes in substance abuse recovery. “It is one of the few things powerful enough to get a woman's attention if she is addicted. Again it depends on the extent of their addiction and the treatment that is available to them,” she adds. “Some women are too sick to be interested in getting well, for themselves or their babies.”

Finding help

When a pregnant woman suffers from addiction, what resources are available to her for treatment and recovery during and after pregnancy? It’s not enough to simply want to get clean, the mother needs to have access to treatment options.

Recreational drugs

We asked Lauren M. Jansson, M.D., an associate professor of pediatrics at Johns Hopkins University School of Medicine, about treatment for pregnant women fighting addiction. “Ideally, women with drug dependencies can access drug abuse treatment, prenatal care and psychiatric treatment (when needed) before or during their pregnancies to be able to work on their recovery and parenting skills,” she says. “Many opioid-dependent women need medication assisted treatment — which includes methadone or buprenorphine maintenance during their pregnancy — to help them to maintain their abstinence from illicit drug use and licit drug misuse. Sadly, these services are not always available, or when they are, not comprehensive in delivery or gender specific,” she adds.

Cali Estes is an addictions coach, and has been a therapist for over 18 years. "Heavy users rarely quit; they will use before, during and after the pregnancy,” she says. “In these cases usually the state steps in and places the baby in foster care. If the mother does not attend rehab and whatever requirements that are set forth for her to get the child back, the baby becomes a ward of the state. These cases are very sad and the women are the worst users,” she adds.

What about the babies?

Babies born to mothers who are struggling with addiction start their lives at an extreme disadvantage. We asked Dr. Jansson about some of the physical symptoms and characteristics she sees in her work in the newborn nursery with babies of addicted mothers. “Women who are drug dependent face many obstacles,” she says. “Those who are opioid and poly drug dependent often have infants that struggle with neonatal abstinence syndrome (NAS). NAS is a constellation of signs and symptoms of infant neurobehavioral dysregulation that occurs in the immediate neonatal period,” she adds. “The syndrome is variable in both expression and intensity between infants.”

Dr. Jansson shared some of the signs and symptoms of NAS in newborn babies.

  • Difficulties with tone and movement. Infants with these problems can have tight muscles and tremors and/or jitteriness. These problems can lead to difficulties in feeding, which can mean weight loss or failure to thrive.
  • Difficulties with state regulation. These infants have difficulty maintaining a quiet alert state, which is needed to interact with their caretakers, and to be able to feed and grow. They can have problems going smoothly from sleep to awake states, and often become irritable and cry.
  • Difficulties with reactivity to stimuli. Infants can have atypical responses to touch, sound, movement or visual stimulation and can become either over-stimulated and poorly reactive, or “pull down” to avoid the stimulation.
  • Problems with autonomic nervous system control. Infants can have gagging, vomiting/diarrhea, color changes, fever, fast breathing or hiccupping, indicating their inability to smoothly regulate their functioning.

These babies can be treated with or without medication to help with their withdrawal symptoms. Supporting these infants through the difficult time of withdrawal takes close attention and support of hospital staff. If medication interventions are necessary, physicians typically use morphine, though methadone and other medications can also be used. “The goal of pharmacologic therapy for NAS is to provide just enough medication so that the infant can eat, sleep and interact,” adds Dr. Jansson. “The medication is gradually weaned off prior to hospital discharge.”

Long-term outlook

Once these babies have worked through their withdrawal period, what is their long-term prognosis? The effects of drugs and alcohol on the developing infant can go way beyond just the physical symptoms. Researching the long-term outcomes of substance exposed infants is difficult to do due to other co-existing factors such as continued maternal drug use, exposure to violence, poor nutrition or adequate well-baby care.

“We do understand that substance-exposed children are at higher risk for medical, developmental, emotional and behavioral concerns as they grow,” shares Dr. Jansson. “Anecdotally, the children that I have been following for over 20 years at the Johns Hopkins Center for Addiction and Pregnancy pediatric clinic have more than their share of these kinds of disabilities. But many can and do function well when their mothers are able to maintain their sobriety and parent,” she says. “And that takes ongoing and multi-disciplinary support from the medical community to provide medical care for parents and children, contraceptive services for women that request them, ongoing drug abuse treatment and psychiatric care for parents, and early intervention services for children when they are needed.”

When these children and their parents can receive the assistance that they need, they have the opportunity to lead happy, productive lives. Treating the whole family is key. “Comprehensive, ongoing, non-judgmental and mindful care can provide these families with what they need to be healthy and productive members of their communities, and to break the cycle of addiction within families,” adds Dr. Jansson.

Note: Dr. Jansson is opposed to the use of the terms "addicted" or "addicts" for infants and children.

More on addiction

Teen addiction: Volunteering decreases substance abuse in teens
Dr. Drew talks teen prescription drug abuse
Prescription drug abuse an American epidemic

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