The Impact of Prenatal Substance Exposure on Children and Youth
For many foster, adoptive, and kinship parents, the possibility of a child being exposed to drugs prenatally may be overwhelming to confront. While for many years, fetal alcohol exposure was the primary concern of adoptive, foster and kinship caregivers, that focus has shifted recently. Opioid deaths have increased tenfold over the past 25 years, and concern has turned to prenatal opiate exposure, which occurs when pregnant women use hydrocodone (Vicodin), oxycodone, oxycodone (OxyContin), codeine, morphine, heroin, fentanyl, methadone, and suboxone. (1)
Much still remains unknown about the impact of opiate exposure on children. Babies can present with different symptoms of Neonatal Opioid Withdrawal Syndrome (NOWS) depending on what type of opioid the mother used, when in the pregnancy the drug use occurred, and whether the mother also used other substances. (2) In addition, a great deal of the research literature assumes that the child is being raised by the parent with the addiction, making it difficult to disentangle the impact of prenatal exposure with the impact of continued exposure to parenting impacted by a substance use disorder. However, there is a growing body of research which points to some repeated and useful findings.
Terms to Know
SUD = Substance Use Disorder
POE = Prenatal Opioid Exposure
NAS = Neonatal Abstinence Syndrome
NOWS = Neonatal Opioid Withdrawal Syndrome
MAT = Medication Assisted Therapy
OUD = Opioid Use Disorder
What Does the Research Say for Newborns?
- NOWS occurs after birth and can present with a wide range of symptoms, including high-pitched crying, decreased sleep, tremors, increased muscle tone, seizures, sweating, fever, increased respiratory rate, feeding difficulty, vomiting, and loose or watery stools. (3)
- If an infant is known to have been exposed to opioids, the American Academy of Pediatrics (AAP) guidance states that the infant should be observed for at least three days to see if withdrawal symptoms develop (4). This can be longer for different kinds of drugs. For some infants experiencing NOWS, medication is necessary, and morphine is used most often.
- According to the AAP, an infant who has had opioid exposure should be seen by the pediatrician within 48 hours of leaving the hospital (5). Parents may need to schedule pediatrician visits more frequently than they would for infants who did not experience exposure. Having an adoption-competent competent pediatrician can help ensure that the unique needs of the child and family are met.
What Does the Research Say As Children Grow?
It is crucial to remember that the impacts of prenatal exposure do not stop once the child is out of withdrawal. “Attention needs to focus upon events after withdrawal. Recognizing that prenatal substance use has consequences beyond the neonatal period provides an enormous opportunity to support not only the infants, but their families and communities (6)." Children with prenatal exposure may be at increased risk for a range of challenging outcomes, including “cognitive differences; developmental delays; speech and language delays; hearing disorders; mental health symptoms associated with attention deficit/ hyperactivity disorder (ADHD); autism spectrum disorder (ASD); visual and motor impairments; poor academic performance from elementary through high school; and difficulties with literacy and math.” (7)
What Should Parents Keep in Mind?
- A child being exposed prenatally by no means indicates that their birth parents are bad people or did not love them. Adoptive, foster and kinship caregivers can have compassion for birth parents while still ensuring that children remain safe and have their needs met.
- Clinics like Johns Hopkins’ Neonatal Abstinence Syndrome Clinic can provide specialized follow-up services related to NAS.
- As a baby grows, if the parents and/or pediatrician are concerned about children’s development, they can access their state’s early intervention system. For a step-by-step introduction to early intervention, visit the Center for Parent Information & Resources overview.
- When a child turns three, they are no longer eligible for early intervention and transition to Part B services, which provide services after Part C and until children are 21. While early intervention services are primarily family-focused, the school becomes more central when children begin to be served by Part B. Families can find a comparison of Part B and Part C here.
- A family accessing early intervention and special education services may come into contact with a range of professionals, including speech-language pathologists, occupational therapists, and physical therapists. It can be helpful for them to become familiar with the range of available services in their area, so that they are prepared should they need additional supports.
- As a family looks for information and services to best support children, they should be knowledgeable about the almost 100 Parent Training and Information Centers (PTIs) and Community Parent Resource Centers (CPRCs) located across the United States. These are designed and funded specifically to work with families who have children with special needs. Families can find their state’s Parent Center here.
There are certainly many unknowns in raising a child who has been exposed to opioids prenatally. This can be compounded by the unknowns that can accompany being a foster, adoptive, or kinship caregiver. However, a fundamental awareness of the issue and openness to the challenges it may present can better equip parents long term. Seeking out adoption-competent professionals who understand the unique needs of foster, adoptive, and kinship families can be an essential part of the journey. Keeping a close eye on children’s development and possible extra needs, as well as being open to accessing services and supports, puts families in a position of strength for best supporting the children they care for.
*This handout is drawn from the NCFA Adoption Advocate, Prenatal Drug Exposure and Adoption.
References
(1) U.S. Centers for Disease Control and Prevention. (2025, June 9). Understanding the opioid overdose epidemic. Department of Health and Human Services. https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html
(2) Patrick, S.W., Barfield, W.D., Poindexter, B.B., Committee on Fetus and Newborn, Committee on Substance Use and Prevention, Cummings, J., Hand, I., Adams-Chapman, I., Aucott, S. W., Puopolo, K. M., Goldsmith, J. P. Kaufman, D., Martin, C., Mowitz, M., Gonzalez, L., Camenga, D. R., Quigley, J., Ryan, S.A., & Walker-Harding, L. (2020). Neonatal Opioid Withdrawal Syndrome. Pediatrics, 146(5), https://doi.org/10.1542/peds.2020-029074
(3) Ibid.
(4) Ibid.
(5) Ibid.
(6) Oei, J. L., Blythe, S., Dicair, L., Didden, D., Preisz, A., & Lantos, J. (2023). What’s in a name? The ethical implications and opportunities in diagnosing an infant with neonatal abstinence syndrome (NAS). Addiction, 118(1), 4-6. https://doi.org/10.1111/add.16022
(7) Louw, B. (2024). Introduction to Neonatal Opioid Withdrawal Syndrome (NOWS). In B. Louw (Ed.) Neonatal Opioid Withdrawal Syndrome: Speech-Language Pathologists and Interprofessional Care. New York: Routledge.
