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The youngest victims of the opioid crisis deserve better

Crushed powdered opioids in spoon with lighter, pills

Crushed powdered opioids in spoon with lighter, pills and syringe. Credit: Getty Images/iStockphoto/karenfoleyphotography

The opioid epidemic has hollowed out communities across the country and touched the lives of Americans of all ages. But we know disturbingly little about the youngest victims of this crisis: babies born with a type of opioid withdrawal called neonatal abstinence syndrome, or NAS.

One in five pregnant women fills a prescription for opioids, and while not all their babies will be born with the syndrome, all are at an increased risk. Just how prevalent is NAS? One government fact sheet noted that more than 21,000 babies were born with it in 2012 alone, and a study from the Centers for Disease Control and Prevention found the incidence of the condition spiked dramatically between 2000 and 2012. But from there the trail seems to go cold.

Wrapping our hands around the extent of this crisis requires better and newer data, first and foremost. That means not only a more accurate accounting from the CDC of how many babies are born with NAS, but a clearer understanding of the long-term complications, a focus on treatment that extends beyond the immediate symptoms, and more support for parents and caregivers.

While research on the impacts of NAS is just beginning, the importance of a child’s first year of life cannot be overstated. Research is clear on infant brain development: the brain develops at a considerable rate during the first several years of life, with each second producing more than a million neural connections. And during this period — as well as during the prenatal period — environmental factors strongly influence both an infant’s brain development and their social-emotional regulation.

Cognitive development functions of the brain also begin in utero and continue into infancy and beyond. Early indicators for cognitive development in infants include attention, face processing, and object perception, all of which can be detected in infancy and are influenced by genetic and environmental factors, such as the infant-caregiver relationship.

Infants suffering from NAS are especially sensitive and require support to mitigate environmental stressors. Tailored infant-caregiver interactions can provide infants with what they need — or they may instead compromise development by contributing to or not buffering stressors entirely. Scientists still have a lot left to learn. But in the meantime, it’s important to know where these children are and who cares for them after leaving the neonatal intensive care unit.

First year, first chance Nationally, the number of children entering the foster care system spiked beginning in 2012, after decades of decline, and many experts believe that increase is directly related to the opioid epidemic.

For example, the percentage of children entering foster care because of parental drug or alcohol use increased from 26 percent in 2006 to 35 percent in 2016. Many children affected by the opioid epidemic who are not in the foster system are living with grandparents, other relatives or their biological parents.

In October 2018, President Trump signed the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act into law, a bipartisan effort that includes provisions on improving care for infants with NAS and supporting families through family-focused residential treatment programs.

The current focus in policy and research is on immediate treatment and interventions for infants with NAS or prenatal opioid exposure, rather than treatment and interventions administered throughout the first year of life. Given the importance of the first year of life on infant brain development, that needs to change — and opportunities for change may exist through the SUPPORT Act or other policies.

Not too late We should also commit to training caregivers of infants with a history of prenatal opioid exposure. Interventions and trainings should be tailored to fit the caregiver’s relationship with the child and include needs for biological and non-biological parents and caregivers.

They should also include guidance on managing feelings of anxiety and distress upon witnessing the infants’ symptoms of withdrawal.The crucial developmental processes that occur during the first year of life makes this an optimal time to foster healthy development and ease the effects of prenatal opioid exposure.

Policymakers need to understand that when infants with NAS leave neonatal care, they are still vulnerable. Congress should take the following steps:

Fund longitudinal research to determine the effects of NAS on children’s developmental outcomes over time Fund research that examines the effects of environmental factors, including home environments and caregiving interactions Fund training programs for adult caregivers and providers of children with NAS As we move forward, policymakers must extend services for infants beyond the first weeks of life. Kids are suffering the dire consequences of this country’s opioid epidemic. Better research and policy can help.

Linda K. Smith is the director of the Bipartisan Policy Center’s Early Childhood Initiative and was a key architect of the military’s child care program.