Sun. May 19th, 2019

Caring for our most vulnerable

My Turn
Date: Fri, 10 Nov 2017

“Many things we need can wait. The child cannot. Now is the time his bones are formed, his mind developed. To him we cannot say tomorrow, his name is today.” — Gabriela Mistral

In America, a baby is born dependent on opioids every 19 minutes. Jackson, like 130,000 other children born in the United States in the last decade, entered the world hooked on drugs — a dependency inherited from a mother battling addiction. In his first three weeks of life Jackson suffered through a form of newborn drug dependency called Neonatal Abstinence Syndrome (NAS). In his mother’s womb he became accustomed to narcotics. After delivery Jackson went into withdrawal. Trembling, wailing inconsolably, sweating, extremely irritable, clenching his muscles, gasping for breath, struggling to eat, sneezing in fits and having severe diarrhea were the hallmarks of Jackson’s first several weeks of life. He would cry at the smallest stimulus, including his mother’s smile, with such force that his body would shudder. Jackson’s course in the hospital was ameliorated somewhat by giving him narcotics in decreasing dosages over an extended period of time. NAS can last for several months.

Jackson recovered enough to be discharged from the hospital. Being born drug-dependent did not kill him. His mother who was high on amphetamine, methamphetamine, Zanax and the methadone prescribed to help her kick a heroin habit fell asleep on Jackson and asphyxiated him. Jackson was sent home to a family ill-equipped to care for him. It only took two weeks before Jackson’s mom became so overwhelmed with the daily care of her baby that she resorted to using substances again. Everybody in the system that cared for Jackson and his mother (NICU physicians, social workers, pediatricians, mother’s probation officer, other health care professionals) knew of Jackson’s dependence but no one ever called child protection services. No plan for safe care was created for him. Here was a tired and depressed mom struggling with addiction and ripe for a relapse. Jackson’s grandfather said, “I’d say he didn’t have a chance in life. He was doomed, that kid, he really was.”

More than 110 cases since 2010 have been identified in 23 states that are similar to Jackson’s: babies and toddlers whose mothers used opioids during pregnancy and who later died preventable deaths. Like Jackson, more than 40 of the children suffocated. Thirteen died after swallowing toxic doses of methadone, heroin, oxycodone or other opioids. The toll is almost certainly higher.

The Federal ‘Keeping Children and Families Safe Act of 2003’ requires states to set up systems to ensure that medical personnel alert child protection workers to newborns “identified as being affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure.” But most states including Pennsylvania are ignoring the federal provisions, leaving thousands of newborns at risk every year. Today, most states require health officials to report only babies who were exposed to illicit narcotics. That means child protection services may never learn of babies suffering withdrawal from opioids that were legally prescribed to pregnant mothers.

“The fact that the mother is in treatment (receiving methadone) is a good thing,” said former U.S. Rep. Jim Greenwood, from Pennsylvania, who championed the 2003 federal law. “But that doesn’t prove that she has a place to live that’s safe. It doesn’t prove that she knows how to parent. It doesn’t prove that there isn’t a violent, other drug user in the home. It doesn’t say anything about the baby’s situation. And this is all about protecting the baby.”

Pennsylvania Rep. Kathy Watson has introduced House Bill 1707 to “put the safety of infants first” by “requiring that all cases of diagnosed substance-exposed newborns be reported by health care providers to county child protective services.”

Please notify your state representative to be supportive of House Bill 1707. Please also be supportive of continuing and ongoing training of mandated reporters in their responsibility of reporting their concerns regarding possible child abuse and neglect. There were so many red flags in Jackson’s case that were obvious to many different agencies involved with his family. Those red flags should have necessitated a call to child protection services. Jackson and his family would have benefited from a safety plan, home nursing, substance-abuse counseling as well as housing and employment help.