Impact of parental substance use on children

Many people with problematic substance use can behave unpredictably, impacting on a child’s ability to predict a parent’s mood or understand what they want. 

This can affect a child's behaviour, because to avoid outbursts from their parent they may not ask for what they need or may find themselves comforting a parent who promises things will get better. 

According to research, having parents with problematic substance use commonly causes difficulties in terms of:

• the family environment (neglect, poverty, hunger and housing)
• exposure to drugs, drug dealing and criminal behaviour
• the emotional wellbeing of the child
• the child’s developmental outcomes
• the child’s progress at school
• parenting behaviour (aggression, excessive discipline and inconsistency) (Dawe et al.). 

Although problematic substance use causes similar patterns of harm in many families, each situation is unique. Each child thinks, feels and sees their parent’s substance use in their own way. The way a parent responds to, loves and cares for their child is affected by the substance they use, the way they use, and their level of use.

Children and young people are affected in three basic ways when their parents and carers are experiencing problematic substance use:

• in utero, through the pregnant mother’s use of alcohol or other drugs. 
• in situations at home or in the community
• through their own substance use.

In utero

To prevent harm from alcohol to the unborn child, people who are pregnant or planning a pregnancy should not drink alcohol. 

Substance use is known to be particularly dangerous to a foetus, as it cannot eliminate drugs as effectively as the mother can.

The use of substances during pregnancy is linked to many potential risks for a baby. A baby who is affected by substances crossing the placenta during pregnancy may:

• unexpectedly abort (miscarriage)
• be born early
• have low birth weight
• be stillborn
• be born with physical abnormalities or intellectual disabilities
• be born with foetal alcohol spectrum disorder
• be born with neonatal abstinence syndrome.

If a pregnant person has been drinking heavily shortly before giving birth or has been withdrawing from alcohol during labour, the baby is at risk of acute alcohol withdrawal. The onset of withdrawal for a newborn may begin 24 to 48 hours after delivery, depending on the time of the mother’s last drink.

If a pregnant person has been drinking alcohol regularly during their pregnancy, the baby will need to be monitored and assessed for foetal alcohol spectrum disorder by a paediatrician, who will guide the baby’s ongoing treatment needs.

Foetal alcohol spectrum disorder and foetal alcohol syndrome

The term foetal alcohol spectrum disorder (FASD) is used to cover the full range of possible effects of foetal exposure to alcohol, while the term foetal alcohol syndrome is used to encompass the severe effects. 

Foetal alcohol syndrome (FAS) is a continuum of permanent birth defects caused by alcohol crossing the placenta to an unborn baby. It typically includes deformities of the head and face, various defects in vital organs and appendages, and intellectual disability and behaviour problems. Partial FAS is where a child has some, but not all, features reported in FAS.

Alcohol-related neurodevelopmental disorders

Alcohol-related neurodevelopmental disorders indicate problems with learning and behaviour experienced by children because of alcohol exposure during their mother’s pregnancy.

Alcohol-related birth defects

Alcohol-related birth defects refer to abnormalities in organs (such as the heart or kidneys) related to alcohol exposure.

Neonatal abstinence syndrome

Neonatal abstinence syndrome (known as NAS) is a withdrawal symptom that occurs because infants are prenatally exposed to opioids, heroin, codeine, oxycodone, methadone or buprenorphine. Babies exposed before birth to these drugs can be become physically dependent on the drugs and be born with withdrawal symptoms.

Other possible effects of amphetamine-type substances for the child may include:

• reduced growth
• stroke or heart failure in newborn
• withdrawal in the newborn
• death
• cognitive problems
• delays in motor development.

Heroin slows foetal growth, causing intrauterine growth retardation and premature birth. If mothers are injecting drugs, there is an increased risk of the transmission of HIV and viral hepatitis.

If women are stable on methadone and using no other substances, the baby will experience withdrawal due to the nature of the prescribed drug. Pregnant women often need a higher dose, which their prescriber reviews. After birth, the dose is usually reduced under the prescriber’s guidance.

Managing neonatal abstinence syndrome

The stress of caring for a baby with neonatal abstinence syndrome may prevent early bonding between mother and baby. Babies may be in a great deal of distress, and this can be difficult for both parents and professionals.   

A parent is already likely to feel guilty and ashamed for the impact their substance use has had on the newborn baby, and negative attitudes from professionals are likely to make them feel worse. (Refer to Engaging with pregnant people.) 

This can make a parent feel like withdrawing from services, drinking or using drugs as they try to cope with their remorse. This can also affect the early bonding and attachment behaviours between a parent and baby.

Safe Sleeping

Sudden and unexpected death in infancy (SUDI) is a general term applied when seemingly healthy infants die suddenly and without warning, usually after the infant has been placed to sleep or during sleep. While infants across all socioeconomic groups die in sudden and unexpected circumstances, infants known to child protection services are over-represented in SUDI deaths.

There are several factors that increase the risk and are referred to in research literature as ‘non-modifiable’ and ‘modifiable’ risk factors (Moon).

 Non-modifiable risk factors are infant characteristics such as age, gender, premature birth, and low birth weight.

Modifiable risks—those that a parent can control—include:

• sharing a sleep surface with another person, especially when that person is affected by alcohol, drugs or prescribed medication
• sleeping on surfaces other than those designed or recommended for infants (such as a lounge, couch or beanbag)
• placing the infant to sleep on the stomach or side
• having loose or soft objects in the infant’s sleep environment such as pillows, doonas and toys
• exposing the infant to cigarette smoke
• overheating. 

Co-sleeping

Any baby is at increased risk of fatal sleep accidents if they share a bed or sleeping surface with someone who has been drinking alcohol, taking medications, taking recreational drugs or medicines with side-effect of drowsiness, smoking, using e-cigarettes or vaping. 

Be clear; a parent should never sleep with their baby, whether in a bed, on a lounge or other surface. The risks of co-sleeping significantly increase when they have consumed alcohol, drugs, prescribed medications that cause drowsiness, or a combination of these (particularly heroin, methadone and cannabis). These slow down a parent’s ability to react and makes them tired and drowsy.

Some of this information may seem simple and obvious, such as ways to encourage habits so babies are always put to sleep in their cot. But when tired and overburdened, parents can benefit from direct guidance of empathetic and respectful practitioners.

Child Safety Service Centres can support families to implement safe sleeping practices by purchasing bassinets through the child related costs budget. The Pēpi-Pod® Program may be available and involves a three phase approach to protect infant breathing, reducing the risk of accidental suffocation.

Mental health and wellbeing

Build a safe, non-judgemental relationship to encourage open communication about substance use and to provide appropriate support to physical, social and emotional wellbeing. 

Low mental health and wellbeing for a pregnant person or new parent who also faces the challenges of substance dependency are often: 

• less likely to access antenatal care 
• more likely to have higher numbers of pregnancies
• at increased risk of domestic violence
• less likely to prioritise seeking alcohol or drug treatment

These factors result in poorer outcomes for the infant. (Refer to the practice guide Infants at high risk.) 

Alcohol

Make it easy to get help by removing the barriers to accessing appropriate information, supports and services for parents who are alcohol dependent. Alcohol and drug use during pregnancy remains highly stigmatised, which makes women reluctant to disclose their substance use when attempting to use services (NOFASD Australia).

Other substances

The impact of a substance on an individual parent and their infant is variable and requires medical professional advice, particular to the individual’s circumstance regarding the safest approach for parent and infant regarding breastfeeding. 

Impact to children and young people

Because many people with problematic substance use can behave unpredictably, children who grow up around them may spend a lot of energy trying to work out a parent’s mood or guessing what they want. 

This can affect a child's behaviour, because to avoid outbursts from their parent they may not ask for what they need or may find themselves comforting a parent who promises things will get better. 
According to research, having parents with problematic substance use commonly causes difficulties in terms of:

• the family environment (neglect, poverty, hunger and housing)
• exposure to drugs, drug dealing and criminal behaviour
• the emotional wellbeing of the child
• the child’s developmental outcomes
• the child’s progress at school
• parenting behaviour (aggression, excessive discipline and inconsistency). 
• Although problematic substance use causes similar patterns of harm in many families, each situation is unique.

 Each child thinks, feels and sees their parent’s problematic substance use in their own way. The way a parent responds to, loves and cares for their child is affected by the substance they use, the way they use, and their level of use. Therefore, the risk assessment and case planning processes must be personalised to each child and their family’s circumstance. 

 A child tends to have one of two responses as they cope and survive:

• the over-responsible ‘take care of everyone’ response
• the under-regulated ‘emotionally and behaviourally overloaded’ response.

Over-responsible: taking care of everyone 

Over-responsible children take on household tasks like cooking, cleaning and laundry at an earlier age than their peers. They provide for their siblings in ways a parent should, by:

• making sure they are dressed and fed
• providing personal care (washing, bathing and bedtime routines)
• signing school forms and documents for their siblings
• protecting them from a parent’s substance use, violence, abuse or neglect.

They often take care of their parents as well, by:

• covering up when they are intoxicated
• cleaning up after them
• constantly making sure the parent is alive.

Over-responsible, ‘parentified’ children miss out on their childhood. They often become adults who are drawn to spouses or partners who have problematic substance use and can spend their entire lives in a state of co-dependence.

Emotional dysregulation: emotional and behavioural overload

A child may:

• ‘act out’ in response to inconsistent parenting
• develop anxiety and depression
• clash with adults
• be aggressive with friends
• get into constant trouble at school.

They tend to:

• cope poorly with frustration
• not know how to calm themselves when frightened or sad
• struggle to form meaningful relationships with others.

They are likely to:

• get poor marks at school
• be identified for special education services
• have a greater chance of dropping out of school or getting involved with the juvenile justice system
• develop their own problematic substance use.

Children of families where substance use is causing harm can often adopt the same patterns and problematic behaviours as their parents. These patterns and behaviours can affect them when they become parents. Substance use affects generations.