Keeping a baby safely at home

Building ongoing safety and wellbeing at home

Practitioners need to ask themselves, the parents and any other supports around the family (including health and alcohol and drug services) a lot of questions to ensure a child is safe at home.

Baby's needs

• How does this baby need to be cared for?
  • What temperament do they have?
  • Are there any health, medical or special needs?
  • What specific nurturing, care, safety and protection is needed in their home?
  • Are there signs of neonatal abstinence syndrome?
  • What are the sleeping arrangements and are safe sleeping practices occurring?
  • How is the baby feeding, particularly at night?
  • Have there been times co-sleeping or unsafe sleep practices have happened unintentionally?

The parents

• How are the mother and father coping in partnership?
• How are they coping, individually and together, with:
  • parenting tasks?
  • the level of care required?
  • their triggers for alcohol and other drugs use?
  • their actual alcohol and other drugs  use?
  • withdrawal or abstinence?
• What role (specific actions) are the mother and father taking in caring for the child? 
• Are there aspects of care they are struggling with, not doing or ambivalent about?
• Are there parts of care she is struggling with, not doing or is ambivalent about?
• What could be the reasons for these struggles or avoidance? Have you made assumptions about this?
• How has information and support been provided to her?
• Does it need to be provided differently?
• Does there appear to be a bond and attachment between mother and child?

The mother

• How does the mother feel about:
  • being a mum?
  • her baby?
  • the things that are good about being a mum?
  • the things that are not good?
  • the unexpected things?
• What emotions and thoughts has she been having?
• How does she respond to her baby crying?
• What physical connection and interaction is she having with the child?
• How does her relationship with her child make her feel about drinking or using other drugs?
• How does her alcohol and other drugs use get in the way of her relationship with her child?

The father

• What role is the father playing in caring for his baby and supporting the mother?
• How does he feel about:
  • being a father?
  • his baby?
  • the things that are good about being a father?
  • the thing that are not so good?
  • the unexpected things?
• How does he respond to his baby crying?
• What physical connection and interaction is he having?  Does there appear to be a bond and attachment between father and child?
• If you are worried about his connection, what worries you and why?
• How does his relationship or life as a father make him feel about drinking or using other drugs?
• How does his alcohol and other drugs use get in the way of his relationship with his child?
• Has he found his new role in the family?
• Is he resentful of the time the mother puts towards the care of the baby?
• Has the baby affected his sense of freedom, for example, not being able to leave the house when he wants?

Engagement and follow-through with community supports

Have the parents:

• seen health professionals?
• gone to or made appointments for themselves or their baby?
• accessed, attended or participated in drug services, parenting services or supports as agreed?
• progressed in the change cycle—have there been steps backwards or forwards?

Breastfeeding

Women with problematic alcohol or drug use should be encouraged to breastfeed with appropriate support and precautions. Consult with health and alcohol and other drugs staff to explore safe options and to support women.

It may be reasonable to advise some women to express breast milk and discard, if they take a drug that was unplanned (rather than advising that they must not breastfeed at all). However, consideration must be given to the safe care of the infant if the mother has impaired judgement due to drug use.

Encourage the mother to consult with a health practitioner to help her understand the benefits and disadvantages of continued breastfeeding.

Planning for safe breastfeeding

Planning to breastfeed starts during pregnancy. Health professionals can work with the parents to make sure the mother breastfeeds safely.

Different substances have different effects on a baby, and every substance including alcohol passes into the breast milk. Use the available fact sheets to talk with mothers, fathers and carers about alcohol, other drugs and breastfeeding.

Suggested conversations with the mother include:

• 'Your local child health nurse can make sure that your baby is in good health and growing well. They can also offer advice on breastfeeding and caring for your baby. It is good to visit regularly.'
• 'There is still a lot we do not know about the effects of drugs on your baby when you are breastfeeding, but it is thought that, even at low levels, taking drugs is likely to:
  • make your baby drowsy, feed poorly and have disturbed sleep patterns and poor weight gain
  • cause behavioural problems.'

A breastfeeding plan

If a mother is still using alcohol, drugs, or both, talk to her about the following:

Alcohol

• When you drink alcohol, it passes into your breast milk.
• There is no known safe level of alcohol consumption while breastfeeding.
• Drinking small amounts of alcohol may reduce your milk supply and may cause your baby to be irritable, feed poorly and have sleeping problems.
• Avoid alcohol in the first month after your baby is born until breastfeeding is well established. However, if you are going to drink alcohol, you should:
  • breastfeed before drinking alcohol, or express and store breast milk before you drink (Refer to Expressing and storing and breast milk.)
  • limit alcohol to no more than 2 standard drinks a day
  • avoid drinking immediately before breastfeeding
  • ‘pump and dump’ breast milk to help keep your supply and for comfort if you are not feeding for an extended time.
• It will take about 2 hours before the alcohol clears one standard drink from your system, 4 hours for 2 drinks, and so on (Source: Western Australia Department of Health).

Drugs

• You should not breastfeed for 24 hours after using amphetamines, ecstasy, cocaine or heroin.
• If you are going to smoke cannabis, breastfeed your baby before you smoke, and smoke outside and away from the baby. Do not have your baby in the same room as the smoke.
• If you have been using benzodiazepines (benzos), your doctor may want to change the type of drug you are taking. Some are better than others for breastfeeding.
• It is not safe to use inhalants while you are breastfeeding.
• It is not safe to breastfeed if you are still injecting drugs.
• If you are sharing or re-using injecting equipment, you can get blood-borne viruses such as HIV. HIV can be passed on to your baby through your breast milk.
• Many drugs such as amphetamines can be cut with substances that can get into your breast milk and harm your baby (Source: Western Australia Department of Health).

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 (American Academy of Pediatrics, 2011).

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.

Give clear messages about alcohol and other drug use and co-sleeping

Co-sleeping is particularly concerning for parents who use drugs. 

Be clear that a parent should never sleep with their baby, whether in a bed, on a lounge or other surface, 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.

Ensure you see where a baby will sleep and always talk about safe sleeping practices with the parents. Provide parents with well-informed and unambiguous messages about safe sleeping. Use language that is strong, clear and consistent. Support them in finding alternative, safe sleeping arrangements.

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 tired and overburdened parents do not always make the right choices, and they need the guidance of empathetic and respectful practitioners.

Monitoring progress in the early stages

Assess progress in the early stages of a person’s experience as a new parent. Good progress here can set the standard for sustainable change. As mentioned, having a new baby is often a very stressful time for new parents. It’s a time filled with anxiety and sleepless nights and a steep learning curve. All of these can be triggers for substance use.

Ask the parents:

• What parts of parenting have you managed well?
• What do you find a challenge?
• What do you enjoy most about being a parent?
• When do you feel sad or bad about parenting?
• How are you coping with night feeding?
• Where is the baby being fed?
• Have there been times you have fallen asleep?
• Have there been times you have felt like or have drank or used?

If the parent tells you they have felt like drinking or using, or have used alcohol or other drugs since the child has come home, ask:

• What was happening that made you feel like drinking or using?
• Who was looking after the baby?
• How was the baby fed?
• Where and when did the baby sleep?
• What was it like before, during and after you used?

Many young fathers want to remain actively involved with their child (Duncan, 2007). Factors most likely to lead to a father’s disinterest or non-involvement are financial difficulties or confusion about childcare (Rhein et al., 1997). Finding a service that is suitable for young fathers is important, as they may feel uneasy attending a playgroup where they are the only male parent.

Help young people overcome any lack of understanding by giving them the information they need about both antenatal and drug and alcohol services. Also help them to overcome other obstacles like transport, finances and support.

Find some more information about support for young parents at the Queensland Government Health and Wellbeing website.

What supporting young parents looks like in practice

Young mothers, and fathers, benefit from practitioners helping them:

• link to community-based support and services
• link to peer support programs so they can share their parenting experiences
• engage in weekly playgroup and positive parenting education sessions
• obtain parenting and relationship information and education
• link in with social, education and vocational training skills workshops
• link to life skill programs and/or mentoring
• make connections with other young parents
• develop positive parenting and relationship skills
• access education, employment and/or training.

You Turn offers a range of programs and services that could assist people aged 12 to 25 years, including a younger parents program.