pressants, often require several
days of nonintensive monitoring.
If multiple substances are used,
the newborn is usually trans-
ferred to a neonatal intensive care
unit (NICU). Specialized NICU
care is necessary because these
patients can have respiratory dif-
ficulties and seizures (Hall, 2015).
Medications, including morphine
and/or phenobarbital, can help
a newborn transition from de-
pendence on the mother’s sub-
stance to a controlled medication
(Reynolds, 2012). Once stable, the
newborn’s medication must be
weaned. So me newborns require
one to two weeks of treatment.
Others need up to three months
of medication. Medications are
weaned based on RN scoring of
the newborn using the hospital-
approved scale. After the last
dose of weaning medication, the
patient is usually monitored for
24 to 48 hours.
A mandated reporter in Pennsyl-
vania includes a person licensed
or certified to practice in any
health-related field under the
jurisdiction of the Department
of State. Anyone who thinks a
child is in danger, for any reason
including parental substance use,
can and should make a report
to ChildLine. The Child Abuse
Prevention and Treatment Act
of 2010 states that healthcare
workers must report to the proper
child welfare agency if infant
opioid exposure occurs, if NAS
symptoms indicate exposure, or
if there is fetal alcohol exposure
(Guttmacher Institute, 2018;
Pennsylvania Family Support
Alliance, n.d.; U.S. Department
of Health and Human Services,
2010). There is still uncertainty
around infants who have NAS
symptoms when the mother has
been taking prescribed medica-
tions. Ten states, including Penn-
sylvania, are working together
to understand the legislation and
create best practices.
Routine appointments or un-
scheduled hospitalizations pro-
vide opportunities for the iden-
tification of parental substance
abuse. In these situations, RNs
can link families to resources and
alert providers. It is helpful to
have familiarity with effective
harm reduction strategies and be
prepared to inform public debate
on evidence-based strategies to
protect and advocate for children.
Between 9 and 24 months of age,
deceleration of weight gain can
indicate family system stresses
and inattention to the child’s
feeding in the home (Smith &
Wilson, 2016). Parental substance
abuse, as well as violent and er-
ratic behavior, place the child at
higher risk of abuse or neglect.
The home environment may be
unsanitary or unsafe, particularly
if illegal or legal drugs, chemicals,
or paraphernalia are accessible
or if drugs are cultivated and/
or manufactured in the home.
Such conditions can lead to poor
child health and developmental
outcomes or maltreatment and
death. The RNs’ assessment skills
and vigilance may save children
from further harm.
Conclusion
Through the year-long ANAI pro-
gram, this article’s authors have
been able to apply new skills and
knowledge in their practice. They
have shared this information
with RNs from across the state
through testimony, an interac-
tive webinar series, and a poster
presentation at PSNA’s annual
meeting.
RNs play an important role in
advocating for children affected
by parental substance abuse. The
authors realize the importance of
active RNs in clinical and com-
munity settings. Caroline and
Ashlee look forward to continuing
to advocate on behalf of patients.
They hope their webinar series
empowers RNs to help children
affected by the opioid epidemic.
References
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Issue 73, 1 2018 Pennsylvania Nurse 19