Substance-exposed newborns: Hospital and child protection responses

Recent federal legislation mandates that newborns identified as prenatally substance-exposed be reported to local child protective agencies. However, the legislation does not outline methods of identifying such newborns. A number of methods of identifying substance-exposed newborns exist, including maternal self-report, urine tests of either mother or newborn, and meconium testing, each with its own benefits and drawbacks. Alcohol poses special challenges, as it is arguably as damaging to newborns as illegal substances, but it is treated differently by the medical profession and by child protective agencies than are illegal substances. There is inconsistency in the reporting by hospitals to child protective agencies, in terms of substances and maternal characteristics. This paper calls for hospitals to develop formal protocols for ascertaining prenatal substance exposure, including establishing objective criteria that both identifies a newborn as substance-exposed and dictates under what circumstances a newborn should be brought to the attention of child protective services. The child protective response is also seemingly inconsistent, and the system should develop appropriate responses for this population of newborns and their families.