Infant prenatal substance exposure and later child maltreatment in the US

Background

Infants with prenatal substance exposure can have a number of health harms and their families need specialized services. Reforms to the Child Abuse Prevention and Treatment Act and passage of the Comprehensive Addiction and Recovery Act mandated procedures and services for infants with prenatal substance exposure.

Objective

To (1) describe a national cohort of infants recorded as infants with prenatal substance exposure after federal reforms; and (2) assess the relationship with services provided at birth for any second confirmed maltreatment reports before age three years.

Participants and setting

Child Files in the US National Child Abuse and Neglect Data System for FFY2018-2022.

Methods

We first described the number of infants with prenatal substance exposure and the services they received during 2018–2020. We then identified second confirmed reports for these same children before age 3 years and assessed any relationship between recurrence and specific services using bivariate and multivariate regression models.

Results

Increasing numbers of infants were identified as prenatally substance exposed during FFY2018-2020 and increasingly received more service referrals. An important proportion (14.3%) went on to have a second, confirmed child maltreatment report before age 3 years. Plans of Safe Care and services related to the Comprehensive Addiction and Recovery Act of 2016 were significantly associated with decreased later confirmed reports as were a small number of other services offered at birth.

Conclusions

Services for infants with prenatal substance exposure are associated with fewer later child maltreatment reports. Further research is needed to examine longer term and other outcomes associated with these services.

Implications for practice

Increasing identification and service provision for mothers using substances during pregnancy can improve child outcomes during the first three years of life.