Caring for Infants

Handling infants who have survived substance exposure can be difficult and demanding. Substance exposed children can suffer from physical pain and also are more sensitive to sound, light, contact, and other external sources of stimulation. Infants still need to have interaction in order to bond with their parents, but it will need to be done at a pace the infant can handle. Caregivers will need to be especially sensitive to the baby and to his/her ability to convey information. The infant's responses will let caregivers know which mode of stimulation he or she likes best (talking, touching, looking, holding). These different modes should be used individually at first. When a positive response from the child is achieved, try adding a second stimulus, such as holding first and then talking. If the early signs that the infant is becoming over stimulated appear, the caregiver is going too fast and will need to decrease the stimuli.

Here are a few suggestions as to how to handle a drug exposed infant.

• Don't allow the infant to become frantic. Early signs that the infant is becoming over stimulated are yawns, sneezes, motor agitation, color changes, and eye aversions. If this happens, give the infant "time out." Lower the level of lighting and reduce the noise level in the infant's room. This will reduce external stimuli and help the infant relax.
• The use of both swaddling and pacifiers are highly recommended. If the infant has reached the frantic state, swaddle him/her immediately. Then, when the infant is calmer, follow with a pacifier. If this doesn't work, hold the infant closely, in a vertical position, and rock gently. Up and down rocking, as opposed to the more usual side to side, appears to be more comforting.
• When they are calm, infants may be unwrapped so they can learn about controlling their body movements themselves. Re-swaddle if the signs of over stimulation appear; i.e., frantic, diffuse activity.
• Stimulate the infant gently, but do interact with him/her. Because they are so cranky and unresponsive, parents are often inclined to leave them to themselves. Things that normal babies often enjoy don't work for these newborns. Remember that babies who are fragile must be respected for what it costs them to interact. They are often willing to interact a bit after they have been fed, so take advantage of these times. This will improve their tolerance for stimulation and may improve their self-control.
• Play with the infant when he/she is ready, not when you want to.

When substance exposed children reach school age, they tend to develop behavior patterns similar to other drug exposed children. These patterns can be used by teachers to help identify children with problems who need specialized education. The patterns of behavior are the following:

• difficultly concentrating and easily distracted;
• unable to sit still, remain quiet, or control body movements;
• clumsy, unable to control crayons and scissors;
• easily frustrated and gives up quickly;
• unpredictably, mood swings;
• poor memory.

A child who was exposed to substances in utero also can suffer from hypersensitivity to stimuli. Visual, audio, or physical stimulation can overwhelm their ability to cope with different situations. When this type of overload occurs the child becomes uncontrollable and may not be able to calm down for several hours. This is not necessarily something that the child wants to have happen, they just do not have methods to deal with the sensory overload. They may not even know what can trigger their loss of control. Helping pre-school and elementary school children learn to recognize and intervene before they are overloaded can dramatically improve their social life and give them some confidence. One of the best methods for creating intervention strategies is to use a behavior log for the child. A log is maintained by anyone who cares for the child during the day. The caregiver logs what the child does throughout their day. Notes should be very detailed around the times that a child loses control of himself/herself. Over time a pattern can be determined from reviewing the child's behavior log to identify the environmental triggers that set the child off. Once these triggers have been established the child and caregivers can determine how to try to minimize the child's exposure to stressful environments. The child can also be taught methods to cope with particular environments or trained how to remove himself/herself from stressful environments. The child may also begin to recognize his/her own feelings before losing control and develop his/her own self-regulating mechanisms.

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