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 non-prescribed 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 & non-pharmacological 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
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 non-prescribed 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 & non-pharmacological 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