CASA of Arizona

Substance Exposure - pg. 2

Opiates



The group of opioid drugs includes heroin, morphine, codeine, methadone, and several other prescription drugs. Isolating the neonatal effects of exposure to one of the opioid drugs is difficult to study. Most women who use opioids take multiple drugs instead of using only one type. But studies have still been done on these multi-drug using individuals to determine the effects the family of drugs has on infants.

In utero opioid exposure has consistently shown a decrease in nucleic acid synthesis and protein production in the brain, suggesting overall brain growth is compromised. The decreased brain growth can lead to many of the problems these children develop in childhood. This assumes the neonate survives to be born. Opioid use has been shown to increase the rate of premature labor, premature rupture of membranes, breech presentation, antepartum hemorrhage, toxemia, anemia, uterine irritability and infection (e.g., HIV, hepatitis, syphilis).

If an opioid-exposed child survives to delivery, they may also have to deal with drug withdrawal now that they have been removed from their supply. Signs of opiate withdrawal include hyperirritability, gastrointestinal dysfunction, respiratory distress, sneezing, mottling, and fever. Tremors and jittery movements, high-pitched cries, increased muscle tone, and irritability are common. Diarrhea is also common, leading to possible electrolyte imbalances and diaper dermatitis. While most of these effects will diminish within a few months to one year, some may last for over three years.

As the opioid-exposed children age, more consequences of their drug exposure can surface. While still an infant, many of the children (3 out of 4) will have motor development delays. They will have muscle rigidity and delays in developing their equilibrium, acquisitional, and transitional motor skills.

As children enter preschool and elementary school, the long-term consequences will become quite noticeable. Their neurological damage will effect their motor planning skills.

Motor planning is how an individual initiates a motor activity, sequences the moves in an activity, coordinates bilateral movement, and rapidly alternates movements. Children with impaired motor planning demonstrate a lack of coordination and show persistent fine tremors. Although the child may be able to accomplish certain motor tasks, the quality and precision of movement is affected. Functional skills such as buttoning clothes, tying shoe laces, using scissors, and completing paper-and-pencil tasks are difficult. The child will lack spatial awareness, orientation, directionality, and left-right discrimination.

Opiate-exposed children can also have communication disorders.

A large majority of polydrug-exposed preschool and kindergarten children are overwhelmed with auditory stimuli and become frustrated due to their lack of ability to express themselves clearly. Younger preschool children with problems articulating needs may have learning disabilities in the language or verbal areas. They may also have problems with articulation due to a disorder known as oral dyspraxia (lack of coordination). Either of these problems can make verbal communication almost impossible. The child understands what they want to say but is unable to pronounce the words or just cannot remember the words. Opiate-exposed children can also develop stutters and slur words. Frequently, children have difficulty following directions; when further analyzed, there appears to be a weakness in short-term auditory memory and auditory sequencing.

Neurobehavioral disruption commonly identified during an infant's drug withdrawal in the neonatal period is a consequence of underlying neurological dysfunction. With neuromaturation, many of these behaviors resolve. However, a great many children continue to demonstrate distractibility, unfocused play, inattention, impulsivity, and in some cases, frank hyperactivity. A recent long-term study diagnosed over 80% of the in utero opiate exposed children with symptoms similar to ADHD once they reached elementary school. The longer each child was followed into his/her early school years, the clearer it became that, although IQ scores were within the normal range, many children continued to demonstrate learning and behavior difficulties that interfered with achievements.

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