Drug and alcohol misuse

Substance misuse includes the inappropriate use of alcohol and illegal substances. Parental substance misuse presents a number of risk factors for unborn and new-born babies. Some of these are outlined below:

New-born babies may experience withdrawal symptoms (e.g. high pitched crying and difficulties feeding), which may interfere with the parent / child bonding process.
Babies may also experience a lack of basic health care, poor stimulation and be at risk of accidental injury.[1]
New-born babies are particularly vulnerable due to their total dependence and need for 24-hour care, supervision and protection.
Parents who are using drugs and alcohol may not be in a position to attend to all the care needs of a new-born infant appropriately.
Unborn babies may be harmed by parental substance misuse depending on the type of substances and the extent of the use. This harm can include premature labour and premature birth, birth defects, growth restriction, placental abruption etc.
Sudden infant death syndrome is between 5 and 10 times more likely to occur in babies who have been exposed to cocaine and is seen to increase risk of premature birth or miscarriage.[2]

Parents and practitioners must consider the impact and harm that continued substance misuse has on an unborn child. Substance misuse services provide specialist multi-agency treatment for pregnant women who misuse substances.

In most cases, referral to specialist substance misuse antenatal services would be appropriate. If the referral is unclear, this should be discussed with a line manager or a professional advisor. If a referral is not made then this should be clearly documented signed and dated.

When a woman, who is pregnant and misuses substances is referred to the specialist ante natal substance misuse service, a pre-birth assessment and plan will be made with the pregnant woman

Risk Factors for Children

The risk to child/ren from parental substance misuse may arise from:

Substance misuse affecting their parent/s’ practical caring skills: perceptions, attention to basic physical needs and supervision which may place the child in danger (e.g. getting out of the home unsupervised);
Substance misuse may also affect control of emotion, judgement and quality of attachment to, or separation from, the child;
Parents experiencing mental states or behaviour that put children at risk of injury, psychological distress (e.g. absence of consistent emotional and physical availability), inappropriate sexual and / or aggressive behaviour, or neglect (e.g. no stability and routine, lack of medical treatment or irregular school attendance);
Children are particularly vulnerable when parents are withdrawing from drugs;
The risk is also greater where there is evidence of mental ill health, domestic violence and when both parents are misusing substances;
There being reduced money available to the household to meet basic needs (e.g. inadequate food, heat and clothing, problems with paying rent [that may lead to household instability and mobility of the family from one temporary home to another);
Exposing children to unsuitable friends, customers or dealers;
Normalising substance use and offending behaviour, including children being introduced to using substances themselves; or being exposed to drug-dealing activities, including potential involvement in county lines activity.
Unsafe storage of injecting equipment, drugs and alcohol (e.g. methadone stored in a fridge or in an infant feeding bottle). Where a child has been exposed to contaminated needles and syringes
Children having caring responsibilities inappropriate to their years placed upon them (see section on Young carers);
Parents becoming involved in criminal activities, and children at possible risk of separation (e.g. parents receiving custodial sentences);
Children experiencing loss and bereavement associated with parental ill health and death, parents attending inpatient hospital treatment and rehab programmes;
Children being socially isolated (e.g. impact on friendships), and at risk of increased social exclusion (e.g. living in a drug using community);
Children may be in danger if they are a passenger in a car whilst a drug / alcohol misusing carer is driving.

Children whose parent/s are misusing substances may suffer impaired growth and development or problems in terms of behaviour and / or mental / physical health, including alcohol / substance misuse and self-harming behaviour. This is particularly the case with unborn babies.

If a child has suffered or is at risk of suffering significant harm as the result of commission or omission on the part of the parent/carer, then the welfare of the child must be paramount.

[1] The London Child Protection Procedures 5^th edition 2017

[2] Andy Taylor (2013) Research in Practice Frontline Briefing, The impact of parental substance misuse on child development, p. 6, www.rip.org.uk