Foster Care Badge, Raising Foster Children

Congratulations! You’ve become a licensed foster parent and are ready for your first placement. We are confident that your training included reliable information about raising kids with prenatal exposure to drugs and alcohol. After all, according to research by the US government, approximately 11% of all children born in the US have prenatal exposure to alcohol, drugs, or, frequently, both. Now that you are ready to accept a placement, do you know enough about prenatal substance exposure to support a foster child in your home?

4 Things We Want Foster Parents to Know About Prenatal Substance Exposure

Whether you’ve had several placements already or are anxiously waiting for that first precious child to come through your doors, continuing to educate yourself about the realities of foster care will position you to support the children in your home in the best ways.

Part of that ongoing education is to recognize that the rates of prenatal substance exposure among children in or adopted from foster care are significantly higher. Experts estimate that about 80% of children involved with the foster system live with the impacts. Often, the issues in a child’s home of origin that led to foster placement stem from the drug or alcohol use by their parents. There is a strong chance that a child coming into your home for foster placement will have a history of prenatal exposure.

Here are four things we want you to know about prenatal substance exposure so you can help this child and be part of their healing journey.

1. The Impacts of Prenatal Substance Exposure

Prenatal exposure, particularly to alcohol, causes damage to the physical structure and development of the brain in a developing fetus. This brain damage is irreversible and lasts across the lifetime of the child.

Prenatal alcohol exposure is the leading cause of intellectual disability in the world. Suppose you know the child has a history of prenatal exposure to drugs in utero. In that case, chances are good they were also exposed to alcohol. Polysubstance abuse is common among pregnant women who report abuse of one substance, even though screening for alcohol at birth is uncommon.

2. The Common Symptoms of Prenatal Exposure

In Babies and Toddlers

A baby exposed in utero to drugs may be diagnosed with NAS (Neonatal Abstinence Syndrome) or NOWS (Neonatal Opioid Withdrawal Syndrome). The symptoms of both conditions include high-pitched cries, sweating, trembling, scratching of the skin, vomiting, and diarrhea. These symptoms often disappear within the first year of the baby’s life.

Infants and toddlers may also exhibit increased irritability, difficulty soothing and sleeping, and difficulty feeding. They can be highly picky eaters throughout childhood. These impacted children may have sensory aversions and intolerance for too much stimulation at once. 

A small percentage of children may have physical characteristics such as a small head, a thin upper lip, and a lack of a groove between the nose and lip (the philtrum). They often have developmental delays and may receive early intervention services.

In School-age Children

School-age children with prenatal substance exposure often struggle with challenging behaviors at home and in school. They may even come to your home with a diagnosis of Oppositional Defiance Disorder (ODD). However, it’s important to remember that it may not be that they won’t do what you ask of them. Instead, kids living with the impacts of prenatal substance exposure often can’t do what you are asking of them due to their brain differences.

Of those children diagnosed with prenatal substance exposure, around 80% are also diagnosed with ADHD. Other common symptoms of prenatal exposure include memory deficits, delays or struggles with executive function skills, slow processing speed, language delays, emotional dysregulation, and having on days and off days.

Kids who were prenatally exposed also often experience dysmaturity, which means a child can have age-appropriate behaviors and skills in some areas of development but may be far behind in others. Tweens and teens may lie excessively, struggle with time and money management, and even steal frequently.

However, many symptoms of prenatal substance exposure can translate into strengths! Kids impacted by these brain differences can also be creative, musical, artistic, funny, friendly, or athletic. They may also have excellent nurture and play skills with younger children or a gentle touch with animals. 

3. Preparing for a Placement of a Child with Prenatal Exposure

There are many excellent resources that you can take advantage of. At the same time, you prepare yourselves to foster a child impacted by prenatal substance exposure. Here are a few of our favorites!

Additionally, when considering if a proposed placement is the right fit for the child and your family, find out as much as possible about their story. Unfortunately, it’s pretty standard for a child to come to you without a specific diagnosis for prenatal substance exposure. Studies have shown that as many as 86% of kids meeting the criteria for a prenatal substance exposure diagnosis do not have one. The child’s caseworker and previous case notes might help you understand the child’s likelihood of challenges and impacts from prenatal exposure.

4. Taking Care of a Child with Prenatal Substance Exposure

CreatingaFamily.org has extensive resources for raising a child impacted by prenatal exposure. In addition to digging into those resources, consider these quick tips to get you started.

Establish structure and routine in daily living.

We don’t mean you should have a long list of rigid rules. Instead, determine how to create consistency and predictability in this child’s daily activities. If they can’t remember what comes next in the week, day, or even the steps in a daily chore, try making them a written list or chart with pictures. There are also many online resources when you search “visual schedules.”

Keep it simple.

Limit the child’s activities, choices, and even room decor. When giving directions, ensure you have their attention first and use as few words as possible.

Find their strengths!

Everyone has something unique that makes them shine. Emphasizing your foster child’s strengths will help them (and you) feel better about their progress. It will also give you something to build on when addressing their struggles. For example, if the child has musical skills, you can find a song to learn anything, from multiplication facts to state capitals. 

Prioritize connection and trust.

All children impacted by foster care need to feel safe. Before addressing any behaviors (outside of safety issues) or maximizing teachable moments, you first must connect with a child through repeated positive experiences. You can form a connection through shared fun activities, like playing a game or watching a movie, and by being available physically and emotionally to the child.

Communicate and collaborate with others.

Discuss your concerns and observations with the child’s caseworker and pediatrician. Keep the lines of communication open with the school and share challenges and strengths with their teachers. It takes a village, and this child deserves nothing less than the best the adults in their life can offer, no matter how long they are in your home.

Finally, prioritize self-care.

We say it almost every time we talk about raising kids impacted by trauma and prenatal substance exposure. Whether you regularly utilize scheduled respite care or soak in a bubble bath each night after the kids go to bed, take care of yourself consistently. 

Contact your social worker, friends, family, and others in your support system for practical help. Be proactive in your self-care — take your time until you (and your family) are at a critical point.

Consider joining a support group. There are many online options, many of which target caregivers of children with prenatal substance exposure. Raising kids impacted by prenatal substance exposure is significantly more challenging, and you deserve to be surrounded by others who get what you are facing.

You are This Foster Child’s Safe Landing Place

You cannot undo this child’s past. However, when you take the time to learn (and keep learning) about their needs, you can be the safe landing place they need in this challenging time. Building trust, forming connections, and using these strategies to support them helps you guide them to become the best version of themselves, no matter how long they are with you.

Image Credits: Pavel Danilyuk; Stephen Andrews; Mikhail Nilov