The use of prescription opioids by
pregnant women has surged in the last
decade, leading to a nearly fivefold increase in newborns experiencing withdrawal, studies have shown.
Many states have responded by prosecuting and incarcerating pregnant women with substance use disorders. However, this punitive approach has no proven
benefits and may harm both women and their babies,
according to a new policy statement from the AAP
Committee on Substance Use and Prevention.
Instead, the policy recommends a public health response to this epidemic that focuses on preventing unintended pregnancies, universal substance use screening for women of childbearing age, improved access to
opioid replacement therapy for pregnant women and
more funding for child welfare systems.
The policy, A Public Health Response to Opioid Use
in Pregnancy, is available at http://bit.ly/2kjFEoh and
is published in the March issue of Pediatrics.
One infant is born every 25 minutes with neonatal
abstinence syndrome (NAS), according to a study cited
in the policy. The diagnosis of NAS may be missed
due to the vagueness of signs and delayed presentation,
Therefore, it is vital for pediatricians to be aware of
substance use during pregnancy so they can provide
effective care for infants, including those with NAS,
the policy states.
The Academy first published a policy on drug-ex-posed infants in 1990, which called for nonpunitive
access to comprehensive care for pregnant women
who abuse substances and their infants. Since then,
more than 20 national groups have gone on the record against prosecution and punishment of pregnant
women who use illegal drugs. However, many states are
considering or have passed laws that allow women to
be criminally prosecuted if their substance use during
pregnancy harms their babies.
The policy notes that such laws may deter women
from getting prenatal care and agreeing to drug testing.
Instead, it calls for a public health approach grounded
in science and makes the following recommendations:
• Primary prevention: The public should be educated about the addictive potential of prescription
opioids to prevent their misuse before pregnancy.
Access to reproductive health services, including
long-acting reversible contraception, should be
• Identification: All women should be screened for
substance use at routine health care visits and sev-
eral times during prenatal care, regardless of age,
race, ethnicity or socioeconomic status. Informed
consent should be obtained from pregnant women
before urine drug testing is performed. The wom-
an should be aware of who will have access to the
results and how positive results will be used for
treatment and reporting to child welfare agencies.
• Access to treatment: Access to comprehensive
prenatal care and treatment should be improved
for pregnant women with substance use disorders, including medication-assisted treatment and
gender-specific substance use treatment programs
that provide nonjudgmental, trauma-informed
• Criminal justice approaches: Health care providers who care for pregnant women should know if
their state requires illicit drug use to be reported
and educate women prenatally about these requirements. States should clarify which substances must be reported and define the health care
provider’s role in reporting.
• Child welfare systems: More funding is needed for social support services and child welfare
systems to ensure the safety of substance-exposed
infants and provide optimal care to families.
Policy calls for public health approach to opioid misuse by pregnant women
by Marjorie J. Hogan, M.D., FAAP
We live in a constantly evolving media world. What
we use now may be obsolete tomorrow. As a result, parents struggle to keep up with the media their children
and teens are using.
Pediatricians can continue to provide the best information and guidance to parents, children and teens
through ongoing education about media, self-aware-ness about our own media use, and an abiding commitment to the health and well-being of those we serve.
Even given the demands of a busy clinic or office,
there are myriad strategies to communicate with and
educate parents and families. Pediatricians can ask key
questions about family screen habits during well-child
visits and provide guidance to parents, children and
teens. Your clinic or office is the best starting point for
• Start by acknowledging the benefits of media,
which can provide entertainment, powerful ideas
and useful information.
• Bright Futures provides questions specifically developed for each age range that can help identify
the type of media use and open the discussion.
• Screen for sexting, cyberbullying and other problematic internet use.
• Recommend parents use the AAP Family Media
Use Plan tool, available at http://bit.ly/2jVk05m,
to evaluate their family’s media use and create a
personal approach to screens in their home.
• Outline the evidence-based risks of excessive media
use, such as the displacement of physical activity
and reading time, obesity, reduced parent-child
communication and interaction, and interference
with adequate sleep and school performance.
• Encourage parents to identify specific concerns
they have about their child or teen such as obesity,
aggressive behavior or inadequate sleep. Then offer
practical suggestions about media use habits.
• Display AAP posters ( http://bit.ly/2jkx6K5) and
brochures ( http://bit.ly/2js Te7I) in your office to
get information across quickly.
• Direct parents to Common Sense Media’s website,
CommonSenseMedia.org, which offers numerous
resources on making positive media choices.
Practice websites provide another place to commu-
nicate with parents about media use. Pediatricians can
save time during visits by directing families to resources
• Place links on your practice website to educational
materials on the impact of media on children, such
as healthychildren.org articles.
• Place a link or a button on your practice website
to the Family Media Use Plan tool.
• Imbed video content from the Academy offering
important information, https://www.youtube.
• Write a blog article for your practice website or
consider posting a regular Q&A on your website
or blog to encourage parents to write in with their
Social media platforms such as Facebook and Twitter provide additional means of communicating with
families about media.
• Connect with parents on social media platforms
to inform them about benefits of connectivity,
identity, creativity and support networks. Set a
good example through your use of social media.
• Encourage the use of privacy settings. The internet is a public forum, and many posts have the
potential to “go viral” or be impossible to delete.
• Share links to relevant content on healthychildren.
org and the Family Media Use Plan tool.
No matter what platform you are communicating
from, encourage families to make good, age-appropriate media choices; be media-educated (media-literate);
make time for outdoor play, creative play, school work,
and unplugged time with friends and family; read daily;
and follow the Academy’s guidance on
Dr. Hogan is a member of the AAP
Council on Communications and Media.
Mastering the Media
Strategies to communicate with families about healthy media use
Families look to their pediatrician to help them make
age-appropriate media choices. Pediatricians can
provide evidence-based guidance and tools from
the Academy to help families create a personal
approach to screens in their home.