By: Vincent C. Smith M.D., M.P.H, FAAP

Original Source: www.aappublications.org


With legalization and/or decriminalization of marijuana, increase in opioid use and the availability of alcohol, substance use is a public health challenge that crosses every demographic and descriptive characteristic and affects a significant number of families. It is estimated that more than 9.4% of the U.S. population 12 years and older used psychoactive substances in 2013.

A new AAP clinical report from the Committee on Substance Use and Prevention aims to help pediatricians manage families affected by substance use in a caring, compassionate, knowledgeable and efficient manner. The clinical report Families Affected by Parental Substance Use is available at http://dx.doi.org/10.1542/peds.2016-1575 and is published in the August issue of Pediatrics.

Myriad problems

Parental substance use is associated with myriad family and social problems. Living in a home affected by substance use may have consequences that pediatricians should be aware of secondary to inconsistency in parenting, disruption/lack of healthy family routines and parental conflict and stress. Sometimes children of substance-using parents are denied the security that is associated with structure provided by a stable household.

“Parental substance use is a complex family problem that places children at significant risk for being abused or neglected,” said Celeste R. Wilson, M.D., FAAP, a co-author of the clinical report and medical director of the Child Protection Program at Boston Children’s Hospital. “In addition to witnessing their parent’s inappropriate use of substances, children may be inadvertently exposed to … situations resulting from their parent’s irresponsible, unbecoming behavior.”

Proficiencies, referrals

Because pediatricians often are the only medical providers interacting with families affected by substance use, they are in a unique position to identify and assess a child’s risk and intervene to protect the child. To increase pediatricians’ awareness of common issues about substance use and its effects on a family, the report:

  • reviews short-term effects of maternal substance use during pregnancy and long-term implications of fetal exposure;
  • describes typical medical, psychiatric and behavioral symptoms of children and adolescents in families affected by substance use; and
  • suggests proficiencies for pediatricians caring for children and adolescents of families affected by substance use, including screening families, mandated reporting requirements and directing families to resources that can address needs and problems.

Because it can be daunting to screen and address substance use issues during a pediatric office visit, the report also describes methods to engage the family, including suggested language that may be less threatening for them.

Pediatricians who identify substance use problems in a child’s family members are not expected to solve, manage or treat these issues; rather, they can partner with other professionals to provide families access to state, regional and local resources. By screening, pediatricians have the opportunity to make a significant difference in the lives of the entire family affected by substance use, according to the report.

Generally, parents want the best for their children but may not be healthy enough to put their children’s needs ahead of their own. If the family interacts with a health care provider who demonstrates empathy and knowledge regarding the effects of substance use and is able to offer the family resources and support, the family often will be amenable to engagement, the report states.

Guidance for pediatricians

  • Screen parents for substance use, and for parents who screen positive, discuss options for access to treatment from their primary care physician or an appropriate specialist.
  • Be alert for signs of child abuse or neglect in children and families affected by substance use.
  • Monitor children for developmental delays and other academic difficulties.
  • Be familiar with mandatory reporting requirements for suspected child abuse and neglect.


Dr. Smith is a co-author of the clinical report and a former member of the AAP Committee on Substance Use and Prevention.

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