A week-old baby lies in one of the ICU bays at one of the Norton Children's Hospital neonatal intensive care units Tuesday, Feb. 13, 2018, in Louisville, Ky. This particular NICU is dedicated to newborns of opioid addicted mothers, that are suffering with newborn abstinence syndrome. Credit: Timothy D. Easley | AP

It’s been almost a year since a 1-year-old girl died in Bangor from acute fentanyl exposure, allegedly after her mother rubbed heroin residue on the girl’s gums to help her sleep.

The girl’s death is an extreme example of the effects of opioid addiction on Maine children. While the Maine medical examiner’s office has recorded just one drug exposure death of a child in recent years, addiction has affected many other Maine children in a range of other ways.

The opioid epidemic in Maine claimed almost 2,000 adults’ lives from 2010 to 2017, according to the Maine Office of Substance Abuse and Mental Health Services. Many of them were parents.

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In addition, hundreds of Maine children are born every year after being exposed to substances in utero, and a growing number of children are living in foster care. In extreme cases, children of addicted parents have died. Sometimes, there are dangerous accidents when young children of substance users get into the supply of their parents’ drugs at home.

There’s also a lot we don’t know, especially about the long-term consequences of the opioid crisis’ effects on children.

Drug-affected babies

The number of drug-affected babies in Maine peaked in 2016, at 1,024. The number has declined since then, reaching 904 last year. Based on the number of drug-affected babies born in the first nine months of 2019 — 632 — that decline is expected to continue.

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Still, in 2018, the number of babies born after being exposed to substances in utero represented 7 percent of births in Maine. And Maine has a higher rate of neonatal abstinence syndrome — the withdrawal condition newborns experience — than the nation: 34.7 cases for every 1,000 births, compared with the national rate of 6.4 in 2015, according to the latest report of the Maine Maternal, Fetal and Infant Mortality Review Panel.

Within 24 hours of birth, babies with neonatal abstinence syndrome can start exhibiting symptoms including seizures, dehydration, tremors and sleeping problems. The traditional approach to treating those symptoms involves medication that generally comes from the same family of drugs as the substance the mother used while she was pregnant, such as methadone for withdrawal from heroin.

More recently, a number of Maine hospitals — including Northern Light Eastern Maine Medical Center in Bangor and hospitals in the Portland-based MaineHealth network — have taken a less medical approach to helping substance-exposed newborns.

The approach, called Eat, Sleep and Console, consists of having caregivers spend time holding their babies, rocking them to sleep and letting them fall asleep in their arms, said Dora Mills, a pediatrician and senior vice president at MaineHealth.

At some MaineHealth hospitals, retired nurses come in to help out with holding babies, training new moms and giving those moms a chance to recover from delivery, said Mills, who is also a former director of the Maine Center for Disease Control and Prevention.

“It’s an old-fashioned strategy but it works really well, particularly when it’s done from the time of birth,” she said. “We found that we dramatically reduced the amount of medication that babies born with NAS require. Eat, Sleep and Console has worked wonders.”

Accidental exposure at home

Once out of the hospital and at home, one consequence of parents’ drug use is that children can find drugs around the house, leading to dangerous accidental exposure.

The Northern New England Poison Control Center received 243 calls about children having accidentally been exposed to opioids from 2014 through 2018.

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“If you’re in substance use disorder state, just by the nature of it, you’re not making the best choices for your child,” said Karen Simone, the poison center’s director. “For opioids, even though they’re not the most common calls we get, when kids get into them they’re very serious cases.”

The number of opioid exposure calls don’t illustrate an increase in accidental exposure over time, nor do they illustrate all cases of accidental exposure because there is no requirement that parents, caregivers and health care providers alert the poison control center.

Unsafe sleep

Only one child has died in recent years as a result of accidental exposure to drugs, according to annual reports from the Maine medical examiner’s office.

But other children have died indirectly as a result of their parents’ substance use, often because of unsafe sleep. For example, if a parent uses drugs and falls asleep with an infant in his or her arms or in the same bed, the baby risks dying of suffocation if the sleeping parent moves on top of the immobile infant.

In April, the Maine Department of Health and Human Services released data showing 22 children whose families were known to the state’s child welfare system had died between the start of 2017 and the beginning of 2019. With five of those children, caseworkers had recommended that a parent seek substance use treatment. Of those five children, two died because of co-sleeping. The others died either because of unspecified accidents or an undetermined reason.

Earlier this year, Maine’s Department of Health and Human Services launched a safe sleep campaign for children called Safe Sleep Maine. The campaign outlines the ABCs of safe sleep: “D” stands for drug-free.

Credit: Troy R. Bennett

Neglect and abuse

When children are raised by parents with substance use disorder, the chances of those families becoming involved with the state’s Child Protective Services system are higher than they are for other families.

The state has seen a slight uptick in the number of children in foster care since 2017, according to Maine DHHS. And a majority of children who came into the state’s custody last year, 52 percent, entered foster care at least in part because of parents’ drug use.

Instances of neglect and emotional abuse — as opposed to physical and sexual abuse — are most commonly associated with parents’ drug use, according to DHHS. And between 2017 and 2018, the state recorded a 23 percent increase in the number of households where caseworkers substantiated reports that children had suffered neglect or emotional abuse.

Credit: Natalie Williams and Eesha Pendharkar

Long-term consequences

The long-term effects on children, in large part, remain to be seen. But as drug-affected babies and other children touched by the opioid crisis grow older, one possibility is that schools will start to see more of their young students requiring special education services.

Schools also are experiencing the effects of parents’ drug use in other ways.

“I’ve heard of that, a lot more kids in general who are stressed, are hungry and don’t have a stable home because of opioids,” Mills said. “In some places where there are very high rates of opioid addiction, our schools are really becoming their home.”