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Anticipatory guidance for infants and children exposed to opioids

The AAP Bright Futures outlines the priorities and risks for general anticipatory guidance offered to all families, which changes/evolves based on the age of the infant/child. Families with prenatal opioid exposure may need more specific anticipatory guidance emphasized during visits as shown in the table here:

Anticipatory Guidance for Prenatal Opioid Exposure

Prenatal

New

1-mo

2-mo

3-mo

4-mo

6-mo

9-mo

12-mo

15-mo

18-mo

24-mo

30-mo

3-y

Opioid and other substances use (alcohol tobacco, marijuana, amphetamines, etc), prescribed and nonprescribed medications


Yes – All visits 

Over the counter medications for the infant

-

-

-

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Perinatal depression (screening)

-

-

Yes

Yes

-

Yes

Yes

-

-

-

-

-

-

-

Parental emotional and mental health well-being

-

Yes – All visits after birth

Parent-infant bonding

-

Yes

Yes

Yes

Yes

Yes

Yes

Yes

 

-

-

-

-

-

Family support/support people

-

Yes – All visits after birth 

Community resources: housing, nutrition/food, financial assistance.

-

Yes – All visits after birth

Pregnancy adjustment & preparing for delivery

Yes

Yes

Yes

-

-

-

-

-

-

-

-

-

-

-

Intimate partner violence

Yes – All visits after birth 

Breastfeeding

Yes – Offered as appropriate based on ability to breastfeed

-

-

-

-

Newborn health risks and NOWS management & nonpharmacologic care (eg, Eat, Sleep, Console*)

Yes

Yes

Yes

Yes

Yes

Yes

Yes

-

-

-

-

-

-

-

Medications for Opioid Use Disorder

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

       

Risk of return to use & accidental overdose

 

Yes – All visits

Medication storage

 

Yes – All visits after birth

Safe sleep

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

-

-

-

-

-

Firearms & home environment safety (burns, poisoning, falls, drowning)

-

Yes – All visits after birth

Environmental concerns (tobacco exposure, lead, pica, mold, etc)

-

Yes – All visits after birth

Developmental screening and surveillance

-

-

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Behavioral and social development and interactions, sibling relationships

-

-

-

-

-

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Pre-school and academic

-

-

-

-

-

-

-

-

-

-

-

Yes

Yes

Yes

*Eat, sleep, console is an approach to monitoring and treating infants with prenatal opioid exposure. If the infant’s ability to eat, sleep and be consoled is impacted by withdrawal the birth parent/caregiver can use methods such as skin-to-skin contact, frequent feeding and holding the baby in a quiet room with low light to calm them.