Second Chance Kids

Women who use drugs during pregnancy expose their unborn children to harmful effects of illicit drugs at the critical period of neurological development as well as physical growth. Scientific evidence regarding the impact of some drugs such as alcohol, heroine and crack cocaine are better understood than the impact of methamphetamine on infants exposed prenatally to these drugs.

During the 1980s epidemic of crack cocaine use, clinical observations documented a variety of possible abnormalities among infants of mothers who used crack cocaine during pregnancy. These initial observations paved the way for more concrete science-based research into the effect of crack cocaine on fetal development and the infant's outcome. Even though the earlier fears regarding possibility of "crack kids" leading a wasteful vegetative life have been allayed, concerns regarding subtle neurological problems are mounting as new technology helps researchers document brain function abnormalities with accuracy not possible in the 80s.

The ultimate goal of scientific research and service providers remains focused on providing the best possible options for drug-exposed infants to achieve better outcomes for developmental and academic functioning.

For pregnant women abusing cocaine or other drugs, early and regular prenatal care can provide protection against known complications of pregnancy such as premature birth, abruption of placenta, high blood pressure and fetal death. Both crack cocaine and methamphetamine are stimulants with the potential to cause blood vessel spasms resulting in compromising oxygen and blood supply to fetal brain and other organs vital for future functioning of the child. In fact, drug abuse at any stage of pregnancy can compromise infant outcome.

EFFECTIVE CARE PLAN FOR DRUG-EXPOSED INFANTS:
Treatment plans based upon systematic behavior observations of drug-exposed infants provide effective and developmentally appropriate intervention with successful outcome potential.

Age-related intervention plans can be organized in the following time spans of early life of drug-exposed infants:

1) 0–6 Months: Problem areas to focus on are:

Habituation Orientation: Soon after birth, infants need to develop skills to adjust stimulus input from their environment. For instance, infants learn to watch people's faces, react to light, darkness and sounds and learn to take interest in their surroundings. These skills are established in the central nervous system based upon maturity and infant-receptor sites. Drug-exposed infants demonstrate poor orientation and habituations in responding to environmental stimuli. They either sleep too much or not enough, and they turn away from visual contact, disregarding objects in the surroundings.

Care Plan: By recognizing alert and passive cycles, the care giver can provide appropriate interactive input for necessary neuromotor development. Planning meal time for an infant who is born small for age and has poor suck coordination requires an organized approach to scheduled meal times, rather than waiting for the infant to ask for nourishment. Likewise, avoiding overstimulation for a child who is in down time is equally important.

Interaction Attachment: Providing opportunities for physical contact, visual regard and verbal interaction becomes an integral part of social development in early stages of life.

Response to Stress: A nonverbal child gives out many signals to indicate stress-generated anxiety. These symptoms range from changes in breathing, heart rate and temperature to stiffened arms and legs with obvious shaking; in the face of continued stress, the symptoms can escalate to inconsolable screaming and breath-holding with vomiting and turning blue.

To Minimize Stress: A care plan to deal with stress-related symptoms should include:

• Providing quiet, calm environment without noise or bright lights.
• Providing warmth and comfort by bundling the child in blankets.
• Encouraging habituation by providing sucking opportunity with pacifier.
• Initiating gentle rocking or soothing motions to help achieve neurobehavioral organization.

3) 3 Years of Age and Older: The potential for slight difficulty in focusing on tasks or in settling down in preschool years may get progressively worse with more demands on focused tasks in school years, and a child showing minor difficulty in controlling emotions may encounter significant social adjustment difficulties in later childhood. These problems get worse with high-risk social environment and unstable family units.

SUMMARY To summarize this complicated issue, a well-organized, developmentally oriented approach toward early recognition and intervention has the best chance to be a successful treatment outcome for drug-exposed children. Even though current research is reassuring regarding the "damaged goods" picture that earlier observations had painted, continued developmental surveillance is required to recognize minor difficulties early so that major problems are avoided later on in life. A team approach of health professionals, parents, early childhood educators and local support network is essential for achieving this goal.t

Dr. Rizwan Z. Shah is Medical Director of the Child Abuse Program at Blank Children's Hospital in Des Moines, Iowa and is on the pediatric faculty at Blank Children's Hospital and the University of Iowa. She has devoted her time to child abuse and neglect since 1981 and started the first clinic for child sexual abuse validation in Iowa. She is involved in professional and public education and legislation efforts in the areas of sexual abuse, drug-affected babies, attachment disorder and the effect of violence on families and children. Dr. Shah has been recognized and has received numerous awards for her work from various national and local organizations. Her work has been featured on front-page news along with several guest appearances on national television.