Babies and children bear mental scars of opioid crisis
Addiction impairs the bond between parent, child
Erin Troup’s toy doctor bag includes the play versions of a stethoscope, a blood pressure cuff, and a blue and gray syringe.
Occasionally, as the licensed professional counselor tries to tease out the roots of a young child’s behavior, she’ll say, “I’m going to give you a shot.” The child’s reaction to the syringe can be telling. “Sometimes,” she said, “the kids don’t even want to touch it.”
Most of the clients Ms. Troup sees in her Mount Oliver office are caregivers and children ages infant to 5 affected by the opioid epidemic. Her specialty is infant mental health — an obscure field that is suddenly in demand because of the growing cohort of children whose parents are dead, debilitated or in recovery due to prescription painkillers, heroin and fentanyl.
“When I came here [in 2015], I was struck specifically with this site, how
many of these children were coming in with a family history of opioids,” she said in an interview at Family Care Connections Mt. Oliver, where she works as a behavioral health specialist for Children’s Hospital of Pittsburgh of UPMC. The office is in the center of one of the region’s worst opioid hot spots.
Parents and children “are meant to be close,” said Ms. Troup. “Opioids are getting right in the middle of that.”
The children of the epidemic may challenge child welfare and educational systems for years to come.
“We are seeing a lot of developmental delays and behavioral health issues for these children,” said Angie Sarneso, director of care coordination for The Children’sInstitute of Pittsburgh, which is upgrading its infant mentalhealth capacity.
Later, they often demonstrate “impulsivity, troubles with attention,” added Richelle O’Malley, a specialist with The Children’s Institute’s project for parents who are adopting. “These are kids who are being kicked out of preschools.”
Infant mental health focuses on the bond that normally develops between a newborn and a parent, and the specialty has been around for a few decades.
“It’s really about the relationship between the primary caregiver and the child,” said Stacey Carpenter, president of the Pennsylvania Association for Infant Mental Health, a 6-year-old organization based in North Point Breeze. A psychologist, she also directs a behavioral health practice based near Philadelphia.
“Baby’s brain development is based on serve and return,” she said. “They’re smiling and cooing and looking at their parents. If a mom is struggling with addiction and working on her recovery, she may not have that same smile. … If they’re not getting those positive reactions, they’re not creating those brain connections, and that can be difficult for them later on in life.”
The result can be conditions known as insecure attachment, or disorganized attachment. Symptoms can include listlessness, withdrawal and disinterest in play or human contact. The child might not develop the ability to form relationships, or may go in the opposite direction and demand excessive attention.
Infant mental health practitioners can tell whether a child and caregiver have appropriately bonded. If not, they can get down on the floor with the parent and child, teach them to play and to interact physically.
Ms. Troup rarely sees a parent in active addiction. She usually sees the child along with a sober caregiver, a grandparent, or even, in one case, a great aunt and the child she’s taken on after the mother’s fatal overdose.
The caregivers are often struggling to understand the young child’s behavior. Through play, she often detects the effects of trauma — the loss of a parent, a nonfatal overdose, family encounters with police, custody battles.
The Children’s Institute’s Project STAR — for Specialized Training for Adoption Readiness — is developing an infant mental health program for adopting parents in Westmoreland County. While some of the targeted infants have other medical complications, most were born in withdrawal from opioids. That condition — called neonatal abstinence syndrome — often leads to sleep problems and incessant crying, which can in turn crank up parental stress.
“With the ones who have been prenatally exposed [to opioids], we do see a lot of ADHD symptoms,” Ms. Troup said. “They’re just not able to focus.”
Studies suggest that early trauma, combined with a genetic predisposition to addiction, puts a child at a much higher risk for substance abuse later in life.
“It’s scary to think that we may have to deal with this intergenerationally,” Ms. Troup said. The few infant mental health practitioners are already swamped, she said, and they are straining to handle growing case loads despite low insurance reimbursements for their services. “There aren’t enough of us.”