Improving Treatment for Drug-Exposed Infants
Treatment Improvement Protocol (TIP) Series 5

Mothers

Health care professionals, hospitals, and clinics have an obligation to identify and assess all women, optimally during prenatal care, but at least at the time of delivery, for substance use.

1. Assessment should include the father and the family context.
2. Identifying a woman as a substance user does not, by itself, imply an obligation to report to child protection or law enforcement agencies. (State laws may differ in this regard.)
3. Maternal use of a substance does not equate to child abuse per se.
4. Assessment should include providing the woman with information regarding her right to confidential or anonymous HIV counseling and testing. Providers involved with the substance use assessment process should receive initial and ongoing training in HIV concerns, and should be able to present the woman with arguments regarding why knowledge of her HIV status may be beneficial to herself and her child. However, assessors must also understand that HIV testing is voluntary, that women have the right to refuse to be tested for HIV, and that this right to refuse testing must be respected. (HIV testing of the infant involves medical and legal questions beyond the scope of this TIP. Suffice it to say that, when the mother has custody of her infant, her informed consent is required for the infant to be tested.)

Guidelines for urine toxicology were developed for a companion volume in this series, Pregnant, Substance-Using Women, and appear in Appendix C.

Infants

Health care professionals, hospitals, and clinics have an obligation to assess newborns who exhibit signs and symptoms of drug exposure, whose mothers have been identified as probable substance users, or whose mothers have signs and symptoms of drug use.

1. Identifying an infant as drug exposed should not, by itself, imply an obligation to report to child protective services or law enforcement agencies. (State laws may differ in this regard.)
2. The finding of substances in the newborn's urine does not equate to child abuse by his or her mother. (State laws may differ in this regard.)
3. Screening of the newborn's urine should be done only for purposes of medical diagnosis and treatment, and should be accompanied by communicating with and informing the mother. As discussed in Chapter 2, in certain circumstances testing infants is medically necessary for the proper and safe care of the infant. Specific informed consent of the mother is not required because of the importance of the medical information to the care of the infant and the fact that delay in obtaining the specimen would cause invalid results due to the short time in which drugs may be detected in the urine.