34.3 Children of Parents and carers who Misuse Substances

Substance misuse may include experimental, recreational, poly-drug, chaotic and dependent use of alcohol and / or drugs. This can include the illicit or misuse of prescribed medication. 

Parental misuse of drugs (illicit or prescribed) or alcohol becomes relevant to child protection when misuse of substances impacts on the care provided to child(ren).

Misuse of drugs (Illicit or prescribed) and/or alcohol is strongly associated with Significant Harm to children, especially when combined with other features such as domestic abuse and parental mental illness.

The risk to child/ren may arise from:

• Substance misuse (of illicit or misuse of prescribed medication) affecting their parent/s' practical caring skills: perceptions, attention to basic physical needs and supervision which may place the child in danger (e.g. getting out of the home unsupervised);
• Substance misuse (of illicit or misuse of prescribed medication) may also affect control of emotion, judgement and quality of attachment to, or separation from, the child;
• Parents experiencing mental states or behaviour that put children at risk of injury, psychological distress (e.g. absence of consistent emotional and physical availability), inappropriate sexual and / or aggressive behaviour, or neglect (e.g. no stability and routine, lack of medical treatment or irregular school attendance);
• Children are particularly vulnerable when parents are withdrawing from drugs;
• The risk is also greater where there is evidence of mental ill health, domestic abuse and when both parents are misusing substances;
• There being reduced money available to the household to meet basic needs (e.g. inadequate food, heat and clothing, problems with paying rent [that may lead to household instability and mobility of the family from one temporary home to another]);
• Exposing children to unsuitable friends, customers or dealers;
• Normalising substance use and offending behaviour, including children being introduced to using substances themselves;
• Unsafe storage of injecting equipment, drugs and alcohol (e.g. methadone stored in a fridge or in an infant feeding bottle). Where a child has been exposed to contaminated needles and syringes;
• Children having caring responsibilities inappropriate to their years placed upon them (see Young Carers Policy 
• Parents becoming involved in criminal activities, and children at possible risk of separation (e.g. parents receiving custodial sentences);
• Children experiencing loss and bereavement associated with parental ill health and death, parents attending inpatient hospital treatment and rehab programmes;
• Children being socially isolated (e.g. impact on friendships), and at risk of increased social exclusion (e.g. living in a drug using community);
• Children may be in danger if they are a passenger in a car whilst a drug / alcohol misusing carer is driving.

Children whose parent/s are misusing substances (of illicit or misuse of prescribed medication) may suffer impaired growth and development or problems in terms of behaviour and / or mental/physical health, including alcohol / substance misuse and self-harming behaviour.

Any professionals, carers, volunteers, families and friends who are in contact with a child in a drug / alcohol-misusing environment must ask themselves "What is it like for a child in this environment?".

Working in partnership across agencies and services is vital for an effective assessment of risk and to ensure the safety of child(ren).

Professional staff in drug and alcohol services must exchange information with child care social workers, health visitors, school nurses and midwives to be able to assess risks for the unborn baby and child - see Information Sharing and Confidentiality.

Care programme meetings regarding drug or alcohol abusing parents must include consideration of any needs or risk factors for the children concerned. Children's Social Care must be given the opportunity and should contribute to such discussions.

Strategy Discussions and Child Protection Conferences must include workers from any drug and alcohol service involved with the family in question.

Maternal substance misuse and drug exposure in pregnancy can have serious effects on the health and development of the child before and after birth. Many factors affect pregnancy outcomes, including poverty, poor housing, poor maternal health and nutrition, domestic abuse and mental health. Assessing the impact of parental substance misuse must take account of such factors. Pregnant women (and their partners) must be encouraged to seek early antenatal care and treatment to minimise the risks to themselves and their unborn child.

Where any agency encounters a substance user who is pregnant and whose degree of substance misuse indicates that their parenting capacity is likely to be seriously impaired, they must make a referral to Children's social care - Making a referral 

Children born after substance misuse or prenatal drug exposure may be recognisable by or show one or more of the following symptoms;

• Brain damage
• Balance problems
• Behavioural problems
• Cognitive delays
• Congenital syndromes
• Difficulty sleeping
• Feeding problems
• Foetal Alcohol Spectrum Disorder (see below)
• Irritability
• Language delays
• Learning disabilities
• Low birth weight
• Premature birth

Newborn babies may experience withdrawal symptoms (e.g. high pitched crying and difficulties feeding), which may interfere with the parent / child bonding process.  Babies may also experience a lack of basic health care, poor stimulation and be at risk of accidental injury.

Where a newly born child is found to need treatment to withdraw from substances at birth, an assessment and a pre-discharge discussion should take place and consideration should be given to making a referral to Children's social care in line with the  Making referral guidance before the child is discharged home.

Foetal Alcohol Spectrum Disorder (FASDs)

Foetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. These effects can include physical problems and problems with behaviour and learning. Often, a person with an FASD has a mix of these problems.

 FASDs refer to a collection of diagnoses that represent the range of neurodevelopmental effects that can happen to a person whose mother drank alcohol during pregnancy. These conditions can affect each person in different ways,  and can range from foetal alcohol syndrome to mild to severe foetal alcohol spectrum difficulties. 

 A person with an FASD might have:

•  Poor coordination
• Hyperactive behaviour
• Difficulty with attention
• Poor memory
• Executive functioning difficulties 
• Difficulty in school (especially with maths) 
• Learning disabilities Speech and language delays 
• Intellectual disability or low IQ 
• Poor reasoning and judgment skills 
• Sleep and sucking problems as a baby 
• Vision or hearing problems 

Physical effects:

Distinctive facial features, including small eyes, an exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper lip (the philtrum). Deformities of joints, limbs and fingers.

Not all children with with FSADs will have typical physical presentation. Some may have all the listed physical presentations, and some may have some or none of these.

• Advice and support: What is FASD - National FASD
• More information can be found here - Fact Sheet - Foetal Alcohol Spectrum Disorders  
• NIICE Quality Standards to improve the diagnosis, assessment and prevention of FASD

Where there are concerns by practitioners involved with a family about a child living in the environment of substance misuse an assessment of the parent's capacity to meet the child's needs should take place to establish the impact on the child of the parent's lifestyle and capacity to place the child's needs before those of their own. A referral to Children's social care should be made- Making a referral