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.