Читать книгу Infants and Children in Context - Tara L. Kuther - Страница 156

Prenatal exposure to opioids—a class of drugs that includes the illegal drugs heroin and synthetic opioids such as fentanyl, as well as pain relievers available legally by prescription, such as oxycodone, morphine, and others—poses serious risks to development. Newborns exposed to opioids prenatally may show signs of addiction and withdrawal symptoms, including tremors, irritability, abnormal crying, disturbed sleep, and impaired motor control (Gupta, 2017; Raffaeli et al., 2017). Prenatal exposure to opioids is associated with low birthweight, smaller head circumference, and altered brain development in newborns (Monnelly et al., 2018; Nørgaard, Nielsson, & Heide-Jørgensen, 2015; Towers et al., 2019). Children exposed to opioids prenatally tend to show difficulty with attention, managing arousal, learning, and inhibitory control (Bazinet et al., 2016; Levine & Woodward, 2018). They perform more poorly than their peers on tasks measuring executive functioning (such as planning) in preschool (Konijnenberg & Melinder, 2015), score lower in measures of intelligence in late childhood (Nygaard, Moe, Slinning, & Walhovd, 2015), and show reduced volume and a smaller cortical surface area in adolescence (Nygaard et al., 2018; Sirnes et al., 2017).

The challenge of determining the effects of prenatal exposure to illegal drugs is that most infants exposed to opioids or cocaine are also exposed to other substances, including tobacco, alcohol, and marijuana, making it difficult to isolate the effect of each drug on prenatal development. We must be cautious in interpreting findings about illicit drug use and the effects on prenatal development because many other contextual factors often co-occur with parental substance use and also pose risks for development. These risks include poverty, malnutrition, inconsistent parenting, stress, and diminished parental responsiveness (Smith et al., 2016). For example, parents who abuse drugs tend to provide poorer quality care, a home environment less conducive to cognitive development, and parent–child interaction that is less sensitive and positive than the environments provided by other parents (Hatzis, Dawe, Harnett, & Barlow, 2017). Children raised by substance-abusing parents are at risk for being subjected to overly harsh discipline and lack of supervision as well as disruptions in care due to factors such as parental incarceration, inability to care for a child, and even death (e.g., from a drug overdose or violence).