Developmental Effects

Alcohol - Fetal alcohol spectrum disorders (FASDs) - facial abnormalities, growth problems, central nervous system problems, problems with learning, memory, attention span, vision and/or hearing, difficulty with social interactions, intellectual disabilities, behavioral problems, problems with the heart, kidney and/or bones.

Tobacco - Attention and behavior issues, hyperactivity, language delays, hypertonicity (tense muscles); negative and externalizing behaviors (higher rates of delinquency, criminal behavior, substance abuse). At risk for learning problems, deficits found in arithmetic, spelling, language, and reading in particular. No consistent effects of fetal tobacco exposure on somatic growth after 24 months of age. 

Marijuana - Problems with attention, impulsivity, memory, and problem solving (particularly visual memory, analysis, and integration) throughout development. Increased rates of aggressive behavior and depression. Reading and spelling deficits.

Prescription Opioids - Miscarriage, low birth weight, Birth defects, premature birth, small head circumference, sudden infant death syndrome (SIDS), neonatal abstinence syndrome (NAS). NAS symptoms begin 24 - 48 hours after birth and occur in 60 - 90% of opioid exposed newborns. Symptoms include: blotchy skin coloring, diarrhea, excessive crying or high pitched crying, excessive sucking, fever, hyperactive reflexes, increased muscle tone, irritability, poor feeding, rapid breathing, seizures, sleep problems, stuffy nose, sneezing, sweating, trembling (tremors), vomiting. Symptoms can last 1 week – up to 6 months. 

Cocaine - Slower psychomotor development, fussier during infancy/more difficult and unadaptable temperament, irritability and lability of state, decreased behavioral/autonomic regulation, poor alertness and orientation, language delays in early childhood. Some studies show increased risk of learning disabilities, executive functioning challenges, ADHD, and oppositional defiant disorder symptoms.

Heroin - Attention and behavior issues. Effects may arise later in childhood for girls than boys.

Inhalants - Hypertonicity (muscle tone abnormality that causes delays in gross motor skills and other physical abilities.

MDMA - Increased risk for learning problems. Negatively impacts motor development during the first year of life, there are dose dependent effects on motor development. Heart problems and higher stroke risk.

Methamphetamine - Limited data available but some show that these children are at risk for lower IQ by age 4, violent behavior by age 8, attention issues and high emotional reactivity. Little data available on school achievement as an outcome.

Prescription Sedatives - Some benzodiazapines are considered safe after the first trimester of pregnancy. Barbituates can cause bleeding and malformation in newborns. Sleep medications may be safe during pregnancy, but more research is needed.

LSD - No conclusive evidence of effects on child development

Ketamine - No conclusive evidence of effects on child development.

Naloxone - Pregnant women can be safely given naloxone in limited doses under the supervision of a doctor.

Synthetic Cannabinoids (K2/Spice) - No conclusive evidence of effects on child development.

Synthetic Cathinones (“Bath Salts”) -  No conclusive evidence of effects on child development.

Salvia - No conclusive evidence of effects on child development.

Neonatal Abstinence Syndrome (NAS) impacts some infants who were exposed to opioids in utero. 

• The effects of Neonatal Abstinence  Syndrome (NAS) usually occur within the first 72 hours, and can last several days to several weeks. In some symptoms can persist for months 
• Neonatal abstinence syndrome is expected and is treatable even when methadone or buprenorphine was used during pregnancy.  
• Most infants will experience some withdrawal but symptoms and severity vary depending on genetics, gestational age, amount and type of substance exposure, and other factors. 
• Babies are not born “addicted” – they experience physical dependence. 

Symptoms of NAS can include:

Treatment for NAS

Pharmacological Care

The Finnegan scale is used to assess NAS symptom severity. In the neonatal intensive care unit (NICU) nurses assess babies' Finnegan scores every 4 hours. Scores greater than 8 result in dosing of morphine or other medications to manage symptoms. Gradually, and as baby tolerates, medication doses are weaned. 

Non-pharmacological Care

Non-pharmacological care in the NICU and at home is essential in improving outcomes in NAS newborns. Nonphamacological approaches can be combined with pharmacological care to better manage NAS symptoms. Key aspect of non-pharmacological care include:

• Having a family member present at the hospital at most times 
• Frequent feedings to replenish calories expended while crying, trembling, tensing muscles, etc.
• Minimizing overstimulation 
• Swaddling and certain types or rocking can help calm crying babies. In the video below, a Speech Language Pathologist demonstrates these techniques.

A mother's past and present substance use can influence providers' recommendations pertaining to breastfeeding. Depending on which substance(s) a mother has used and the timing of use, a provider may advise against breastfeeding. In general...

• Breastfeeding is typically not recommended when there is any illicit drug use (i.e. heroin, cocaine). 
• Though some providers have advised against breastfeeding when mothers are using marijuana, others have disagreed. When in doubt, it’s likely safer to advise against it. 
• Using tobacco/nicotine products should be discouraged, but it is still healthier for the baby to be breastfed when mothers are smoking. 
• For more detailed information about breastfeeding substance exposed newborns, click on the PDF handout below.