Substance Abuse& Children :Substance Abuse& Children Presented by: Melissa Hinton, RN, BSN Ouny Kim, RN, BSN Bridget Penick, RN, BSN Amanda Turner, RN, BSN


The Effects Of Alcohol, Nicotine & Illicit Drugs on the Fetus and Newborn :The Effects Of Alcohol, Nicotine & Illicit Drugs on the Fetus and Newborn By Bridget


Substance Abuse History :Substance Abuse History Centuries-old problem No prior consideration Extensively studied over past 30 years….BUT with limitations!


Background :Background Use versus abuse Stigma Fear of separation Polydrug abuse Other factors National Household Survey on Drug Abuse Fetal brain development


Substance Abuse: Nicotine :Substance Abuse: Nicotine Premature delivery Miscarriage Low-birth-weight babies Stillbirths SIDS Blood vessel constriction Second-hand smoke complications Smoking by children and adolescents


Substance Abuse: Alcohol :Substance Abuse: Alcohol When mom drinks, baby drinks What amount is safe? When is it safe? Sexually active women


Alcohol :Alcohol Fetal Alcohol Syndrome (FAS) Lifelong condition Physical and mental disabilities Abnormal facial features Growth deficiencies Central nervous system problems 100% preventable!!


Alcohol :Alcohol Fetal Alcohol Spectrum Disorders (FASDs) Includes FAS Fetal Alcohol Effects (FAE) Alcohol-Related Neurodevelopmental Disorder (ARND) Functional or mental problems Behavioral and/or cognitive abnormalities Alcohol-Related Birth Defects (ARBD) Problems with heart, kidneys, bones, and/or hearing All 100% preventable!!


Alcohol :Alcohol Children with FASDs exhibit: Small size Small stature Facial abnormalities Poor coordination Hyperactive behavior Learning disabilities Mental retardation Poor reasoning skills Sleep/suck distrubances Secondary conditions


Substance Abuse:Illicit Drugs :Substance Abuse:Illicit Drugs Marijuana Slow fetal growth Pre-term labor Withdrawal-like symptoms Attention deficit disorder Decreased fertility


Illicit Drugs :Illicit Drugs Heroin Poor fetal growth Premature rupture of membranes Premature delivery Stillbirth Low-birth-weight SIDS Withdrawal symptoms


Illicit Drugs :Illicit Drugs Cocaine Miscarriage Pre-term labor Poor intra-uterine growth Low-birth-weight Mental retardation Cerebral palsy Stroke, heart attack, or death Normal intellect


Illicit Drugs :Illicit Drugs Methamphetamine Poor intra-uterine growth Smaller than average head Preterm birth Placental problems Possible birth defects Withdrawal-like symptoms


Fetal Alcohol Syndrome :Fetal Alcohol Syndrome By Amanda


Clinical Manifestations of Fetal Alcohol Syndrome and Diagnosis :Clinical Manifestations of Fetal Alcohol Syndrome and Diagnosis Evidence of facial anomalies Growth retardation CNS and neurodevelop-mental abnormalities Fig A: Institute of Medicine, 1996 Fig B: New England Journal of Medicine, Massachusetts Medical Society Fig C: Jones et al., 1973


Facial Abnormalities :Facial Abnormalities Short palpebral fissures* Thin vermillion border* Long, flat philtrum* Short nose Flat midface Diagnostic Non-diagnostic Epicanthal folds Low nasal bridge Ear anomalies Micrognathia Strabismus Ptosis


Growth Restriction :Growth Restriction


CNS and Neurobehavioral Abnormalities :CNS and Neurobehavioral Abnormalities Microcephaly Intellectual Impairment Developmental Delay Irritability in Infancy ADHD in Childhood Seizures Delayed or deficient myelination Agenesis or underdevelopment of the corpus callosum


Other Abnormalities :Other Abnormalities Cleft palate Heart and Kidney Anomalies Radioulnar synostosis Flexion contractures Aberrant palmar creases Scoliosis Hemivertebrae


It’s better to prevent than to treat…damage is irreversible! :It’s better to prevent than to treat…damage is irreversible! No cure for FAS sx’, physical features or brain damage Manage associated birth defects Intervention for potential behavioral and cognitive impairments. 100% Preventable!! Educate women on the potential risks of alcohol use on their baby. Treatment Prevention


Outcomes :Outcomes Are dependent on the severity of impairment Outcomes are more positive when: Diagnosis is made early Are placed in special education with social service involvement Are in a nurturing environment. Have the absence of violence


Interventions For Families With Substance Abuse Problems :Interventions For Families With Substance Abuse Problems By Melissa


Detection and Assessment :Detection and Assessment Screening Tools


Physical Warning Signs :Physical Warning Signs Change in sleeping patterns Bloodshot eyes Slurred or agitated speech Sudden or dramatic weight loss or gain Skin abrasions/bruises Neglected appearance/poor hygiene Sick more frequently Accidents or injuries


Behavioral Warning Signs :Behavioral Warning Signs Loss of interest in previously enjoyed activities Emotional instability Depression Avoiding eye contact Sense that the person will "do anything" to use again regardless of consequences Loss of control or choice of use (drug-seeking behavior) Missing school or work Failure to fulfill responsibilities at school or work Complaints from teachers or co-workers Hyperactive or hyper-aggressive Reports of intoxication at school or work Emotional School & Work Drugfree.org


Behaviors :Behaviors Going out every night Change in friends or peer group Change in clothing or appearance Disappearances for long periods of time Running away Unusual smells on clothing or breath Heavy use of over-the-counter preparations to reduce eye reddening, nasal irritation, or bad breath Unusual containers or wrappers Friends and Relationships Personal Habit


Secretive Behaviors :Secretive Behaviors Alcohol missing from the home Prescription medicine missing Money missing Valuables missing Secretive phone calls Lying and covering up Locked doors Hidden stashes of alcohol


Clinician Screening Tools :Clinician Screening Tools Rapid Screening Instruments CAGE ASSIST ASI-lite SDS AUDIT DAST Comprehensive Assessment Tools: The Addiction Severity Index (ASI) Diagnostic Interview Schedule (DIS/DSM) Diagnostic Interview Schedule for Children (DISC)


Interventions for users :Interventions for users Substance Abuse in Children


Emergency Intervention :Emergency Intervention Has lost consciousness Has had a seizure Suicidal Withdrawal symptoms with heavy drinking


Clinic Interventions :Clinic Interventions Rapid or comprehensive screening with complete physical exam Motivational Interviewing Referrals to local resources: Al-anon or treatment center Referral to detox program Referral to counseling (pediatric specialty preferred) Consider alternative schools


Family Interventions :Family Interventions


Family :Family Parent information sites: http://www.timetotalk.org/ http://www.aa.org/?Media=PlayFlash Al-anon Al-anon Families Counseling for the child and the family: may be available through human service agencies, mental health clinics, treatment programs EAP


References :References Batshaw, M., (2002). Children with Disabilities, 5th edition:. Baltimore: Paul H. Brooks Publishing Co. Chambers, C. (2006). Fetal Alcohol Syndrome. Retrieved November 28, 2008, from http://www.emedicine.com/ped/TOPIC767.HTM Current Trends Statewide Prevalence of Illicit Drug Use by Pregnant Women-Rhode Island [Electronic Version]. Retrieved November 30, 2008 from http://www.cdc.gov/mmwr/preview/mmwrhtml/00001598.htm Fetal Alcohol Spectrum Disorders [Electronic Version]. Retrieved November 30, 2008 from http://www.cdc.gov/ncbddd/fas/fasask.htm Illicit Drug Use During Pregnancy [Electronic Version]. Retrieved November 30, 2008 from http://www.marchofdimes.com/professionals/14332_1169.asp NIAAA. (2008). Module 10K Fetal Alcohol Exposure. Retrieved November 28,2008, from http://www.pubs.niaaa.nih.gov/.../Module10K.html. Shahul, E., Gfroerer, J. (2003). Pregnancy-Related Substance Use in the United States During 1996-1998. Obstrectics and Gynecology, 101, 2, 374-379. Wang, M. (2008). Prenatal Drug Abuse and Neonatal Drug Withdrawl [Electronic Version]. Retrieved November 29, 2008 from http://www.emedicine.com/ped/TOPIC2631.HTM#IntroductionBackground. 2004 Surgeon General’s Report-The Health Consequences of Smoking. Impact on Unborn Babies, Infants, Children, and Adolescents [Electronic Version]. Retrieved November 29, 2008 from http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2004/highlights/1.htm Alcholics Anonymous. Retrieved November 27, 2008 from http://www.aa.org/?Media=PlayFlash The partnership for a Druyg-Free America. Retrieved November 27, 2008 from http://www.drugfree.org/Intervention/