Children and Families Affected by Parental Substance Use: Clinical Report

Children and adolescents whose parents have an alcohol or substance use disorder are at increased risk of short- and long-term sequelae, ranging from medical conditions to psychosocial, safety, and behavioral challenges. In the course of providing health care services to children, pediatricians and other pediatric clinicians are likely to encounter families affected by parental substance use and are in a unique position to support the well-being of both the child and family. The purpose of this clinical report is to briefly discuss the epidemiology of substance use during pregnancy and while parenting in the United States; highlight the influence of bias, racism, and other structural inequities on families affected by substance use; describe the known risks associated with prenatal and postnatal parental substance use; discuss use and interpretation of toxicology testing as part of a substance exposure evaluation; review approaches to screening for prenatal and parental substance use; propose key topics for anticipatory guidance in the pediatric clinic; identify and address concerning parental and child presentations related to parental substance use leading to concern for child abuse or neglect; and provide recommendations for pediatric clinicians involved in the care of children from families affected by substance use.