The present study collected quantitative and qualitative data from and in partnership with parents and caregivers raising children with POE. Parents shared the challenges and joys of raising these children and provided details on the children’s exposures. This study extends the existing literature in several important ways. First, where the bulk of existing research on the developmental implications of POE is focused on infants, toddlers, and preschoolers, the present study collected data on school-age children. Second, existing literature notes the prevalence of polysubstance exposure among children with POE. The present study provided detailed information on which substances constituted polysubstance exposure and at what point the children were exposed in the pregnancy. Third, the present study extends exposures from substances to be inclusive of adverse childhood experiences. Finally, in an attempt to examine the implications of POE for the whole child, and not just their reading scores, the present study asked parents and caregivers about their children’s strengths as well as their struggles, and cast a wide net to capture a myriad of developmental implications.
Overall, the results extend our understanding of the cognitive, motor, language, and behavioral challenges children with POE may have into school-age. The results also point to the considerable complexity of the exposures the children experienced from an average of five different substances to adverse childhood experiences. While these many exposures complicate the potential connection between POE and developmental outcomes, the many similarities between the present study’s findings and multiple previous meta-analyses indicate an emerging confluence. Across existing research, we can safely assume that the types and amounts of polysubstance use and adverse childhood experiences varied significantly, the one constant across them is the inclusion of POE and their consistent findings of cognitive, motor, language, and behavioral challenges.
Future research should try and distinguish if the developmental implications associated with POE vary by the type of opioid (e.g., heroin vs. buprenorphine). Further, the present study, in asking parents and caregivers to share their children’s strengths, raises additional questions for future research. For example, some parents and caregivers reported their children were incredibly smart, some had even been tested as gifted, while others reported significant cognitive delays. This complicates the potential argument that POE is associated with cognitive impairment. As another example, the prevalence of social and emotional delays and intense and even violent tantrums could lead to an assumption these children could struggle socially. And yet, some parents and caregivers were most proud of the social magnetism of their children and their ability to make fast friends. This suggests potential nuance and variation in the development of children with POE that should be explored.
The limitations of the present study include the sample is less representative than prior research, not only because it is smaller and concentrated in two states, but also because it may be a more severe sample. This sample had a higher prevalence of polysubstance use (Smith et al., 2022) and longer lengths of stays in the hospital (Bhatt et al., 2021) compared to prior research. Further, a survey asking parents about the development of their child with POE may attract more parents with concerns. Another limitation is the use of parent and caregiver report, especially as the bulk of the parents were foster and adoptive parents. This especially limited our understanding of the polysubstance exposures, there were high rates of respondents answering “don’t know” for these questions. Future research should center the perspectives of birth parents.
In conclusion, with prenatal opioid use continuing to rise (Hirai et al., 2021) and research indicating significant developmental implications of POE extending into school age, states must invest in services for these children and their families while research continues to gain medical clarity. While there are best practices for how to care for neonates with POE, there are no best practices for taking care of the toddlers, preschoolers, and school-age children with POE, who can face significant challenges. Lacking best practices in how to support these children across their developmental trajectory, they are at risk of educational and medical care inequities. Parents told us their Kindergartners had been referred to juvenile justice programs for their behavior, their children had been diagnosed with oppositional defiance disorder, and child care providers had hit or mistreated their children in frustration. Rather than punishing these children for having challenges beyond their control, we should support them and their families and help these kind and resilient shining stars thrive. The more providers and teachers know about these children and how to support them, the better for all involved.