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Therefore, pediatricians need to know how to assess a child’s risk in the context of a parent’s substance use.

The purposes of this clinical report are to review some of the short-term effects of maternal substance use during pregnancy and long-term implications of fetal exposure; describe typical medical, psychiatric, and behavioral symptoms of children and adolescents in families affected by substance use; and suggest proficiencies for pediatricians involved in the care of children and adolescents of families affected by substance use, including screening families, mandated reporting requirements, and directing families to community, regional, and state resources that can address needs and problems.

Children who were exposed to crystal methamphetamine prenatally may have developmental delays in communication, personal and social skills, fine and gross motor skills, and problem-solving skills as well as aggressive or withdrawn behaviors.

Whether secondary to inconsistency in parenting, disruption or lack of healthy family routines and rituals, or parental conflict and stress, children of substance-using parents typically are denied the security that is associated with structure and stability provided by appropriate parenting.

The parent’s SUD and the violent and erratic behavior that may be associated place the child at higher risk of being abused or neglected (Tables 2 and 3).

Mandatory involvement of child protective services helps ensure a child’s safety but may result in the child being placed in an alternate living situation with a relative (ie, kinship care) or unrelated caregiver.

For example, children may have their ears examined for chronic otitis media because of greater exposure to smoke or large breathable particulates in their homes or for more frequent developmental assessments, given risks of emotional and behavioral disorders, delays in expressive language, and mental illness.

Pediatricians who help identify substance use problems in a child’s family members are not expected to solve, manage, or treat these problems; rather, they can assist families by working in partnership with other professionals to provide access to state, regional, and local resources available to families.

Children exposed to a parent’s substance use commonly experience educational delays and inadequate medical and dental care.The purposes of this clinical report are to review some of the short-term effects of maternal substance use during pregnancy and long-term implications of fetal exposure; describe typical medical, psychiatric, and behavioral symptoms of children and adolescents in families affected by substance use; and suggest proficiencies for pediatricians involved in the care of children and adolescents of families affected by substance use, including screening families, mandated reporting requirements, and directing families to community, regional, or state resources that can address needs and problems.Throughout this report, the term parent is used, but the discussion could apply to any primary adult who cares for a child, including guardians, grandparents, and foster parents.Being familiar with effective harm reduction strategies and being prepared to inform public debate on how to use evidence-based strategies to protect and advocate for children whose parents have SUDs are important roles that the pediatrician can assume.In addition, medical professionals are mandatory reporters of suspected child maltreatment and may be the only professionals who have the opportunity to recognize that a child, especially one of preschool age, has been abused or neglected.As defined by the National Alliance for Drug Endangered Children, drug-endangered children are those who are at risk for suffering physical or emotional harm as a result of their caregiver’s substance use, possession, manufacturing, cultivation, or distribution.Parents’ substance use may affect their ability to consistently prioritize the child’s basic physical and emotional needs over their own need for substances.Because there is passive diffusion across the placenta of substances smaller than 500 dalton (d), most illicit and some other substances used by a pregnant woman will directly affect the fetus (eg, methamphetamine = 149 d, buprenorphine = 467 d, tetrahydrocannabinol [THC] = 314 d).Fetal exposure to cannabis has been associated with subtle neurobehavioral disturbances (ie, exaggerated and prolonged startle reflexes and increased hand–mouth behavior), high-pitched cries, and sleep cycle disturbances with electroencephalographic changes in the newborn period.Children exposed in utero to cannabis may have a small-for-age head circumference well into their teenage years and permanent neurobehavioral, cognitive, and intellectual deficits that vary depending on the timing and degree of in utero exposure.Specifically, heavy use (defined as more than 1 joint, or approximately 10 mg of THC, per day) during the first trimester has been associated with lower verbal reasoning skills in the child, whereas second trimester use was associated with impairments of the child’s composite short-term memory.

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