Some Drug-Exposed Infants Go Undetected

Because not every baby is tested for drugs at birth and some do not initially show signs of drug exposure, it is impossible to say how many drug babies are actually born in Orange County each year.

One study--based on a survey returned by 19 of 28 Orange County hospitals--estimated that 1,248 drug babies were born here last year.

Cocaine remains the most frequently detected drug, followed by methamphetamines, according to the study by Coordination of Resources to Infants for Better Services (CRIBS), an interagency coordinating council.

Mary Harris, program analyst for the Orange County Social Services Agency, believes that the 1,248 figure is conservative.

“Hospitals are not legally mandated to report a positive toxicology screen, so we’ve always felt there was just a percentage that came to our attention,” said Harris, who estimates that only 20% to 25% of drug babies in the county are referred to Social Services’ Child Abuse Registry.

In October, Harris said, Social Services was involved with 24 cases of newborns who tested positive for drug exposure. The number, for unknown reasons, had dropped from an average of about 25 a month to 22 a month in previous months.

To get a better idea of how many drug-addicted babies are being born in Orange County, blind drug testing in 26 county hospitals was conducted during an unannounced seven-day period this fall. Results of the confidential study, co-sponsored by the March of Dimes, public health agencies and UCI Medical Center, will not be made public for several months.

Cheryl Milford, assistant clinical professor of pediatrics at UCI Medical Center, said most babies exposed to opiates such as heroine and methadone go through physiological withdrawals. But babies exposed to stimulants such as cocaine and amphetamines may have tremors, feeding problems or sleeping problems and don’t go through a life-threatening withdrawal.

The vast majority of drug-exposed babies, she said, “probably are not going to show any significant difficulties like retardation. We don’t know in terms of the more subtle things like behavior problems or mild learning disabilities. Nobody’s been able to follow them that far yet, but those studies are in progress right now, of which we are one.”

Harris said some hospitals either have no protocol or they have varying policies for testing drug babies. “Or, they might test a baby and determine that things otherwise look OK,” she said. “The hospital and the (mother’s) doctor make the decision whether or not to test and what to do once they have tested.”

The test, she noted, only detects drugs that the mother has ingested in the last few days, “so there’s a lot of room for variation in how things are handled. The mother may have explanations they think feasible” for why drugs were detected.

Harris said that if Social Services is called by a hospital, a social worker will talk to hospital personnel and the baby’s parents to determine whether the baby would be at risk for abuse or neglect if he went home.

As required by law, Harris said, an emphasis is placed on trying to keep the mother and baby together if at all possible in order to maintain the parent-child relationship.

Harris said that if the parents are cooperative and it is determined that intervention will reduce the risk of abuse or neglect to the baby, the services of a social worker are offered to the parents.

“Generally,” she said, “that consists of having a social worker making monthly visits to the family, helping them find different resources in the community they might need and helping the parent find drug treatment--whatever might be called for.”

The condition of the baby is also part of the decision-making process, said Harris. “It’s difficult when we don’t see all the symptoms right away, because then everyone is left not sure of what special needs the child will have.”

If it is determined that the baby would be at risk even with all available services to the parents, the social worker would ask for a legal order to prevent the hospital from releasing the baby.

Harris said that any time Social Services places a hold on a baby, a detention hearing will be scheduled within 48 hours. “If we wish to continue protective custody, we must file a petition” with juvenile court to give Social Services legal authority in the situation.

Harris said three things can then happen: “The court can dismiss our petition, they can return the baby to the parents and order us to supervise, or they can order the baby to be placed in foster care.”

Harris said the Social Services Agency for years has been encouraging hospitals to make reports of substance-exposed babies “so we could assess the situation.”

But Harris believes that recently passed state legislation, the Perinatal Substance Abuse Act, may have a negative impact on the number of drug babies reported to the Child Abuse Registry.

The legislation says that a positive toxicology screen at the time of delivery of an infant is not in and of itself a sufficient basis for reporting child abuse or neglect. It goes on to say that hospitals shall not report babies who have a positive toxicology screen unless other risk factors are identified.

“So it places the responsibility of doing a more in-depth assesment--of the mother’s situation, of the child’s special-care needs and the risk of neglect or abuse of the child--on the hospital personnel,” said Harris.

“I think that if hospitals had been already spending the time to consider all the circumstances that it (the legislation) should not make any difference. But I’m concerned that other hospitals will not have the time or the interest to work with families on this and, as a result, they simply will not receive any services.”