Trends in infants reported to child welfare with neonatal abstinence syndrome (NAS)

Abstract

BackgroundSubstance abuse among caregivers is a known risk factor for child maltreatment, and some of these children subsequently come to the attention of the child welfare system. The recent opioid epidemic has led to rising numbers of women who use opioids during pregnancy and infants born with neonatal abstinence syndrome (NAS), raising the question of whether there has been a consequent rise in the numbers of these infants reported to the child welfare system. The purpose of this study is to examine the trend in the number and percentage of infants reported to the child welfare system with neonatal abstinence syndrome (NAS) from 2004 to 2014, and determine whether the trend is distinct from the trend in the percentage of infants reported with fetal alcohol spectrum disorder (FASD). MethodsWe analyzed National Child Abuse & Neglect Data System (NCANDS) data on reports of infants (aged <1 year) with NAS between 2004 and 2014. Due to state differences in data collection and data quality across the study period, the sample included reports from 10 states. We utilized a Generalized Estimating Equations (GEE) model approach to examine the trend over time in the percentage of NAS and FASD cases reported to child welfare in our 10 state sample. Year was used as an identifying variable and Substance Type was repeated over time and clustered by State. ResultsThe number of reports of infants with NAS for the 10 states was the lowest at 3073 in 2009 and highest at 4806 in 2014. The average percentage of cases of NAS reported rose from 4.72% in 2004 to 9.19% in 2014. The results of the GEE revealed a significant main effect of Substance Type (p = 0.015) and Year (p = 0.009), indicating that overall, averaged across time, the percentage of NAS reports was greater than the percentage of FASD reports and averaged across substance type, the percentage of substance-related reports increased over time. DiscussionNAS reports increased significantly over time, most pronounced between 2010 and 2014, while the trend for FASD reports did not show significant change over the study period. Moreover, the child welfare reports data obtained from the 10 state sample aligned with national NAS incidence data. Although recent efforts to curb prescribing and other means of supply have been implemented, it remains to be seen whether the large rise seen will continue or be ameliorated by these public health initiatives. However, overall these findings suggest that immediate efforts are needed to prepare the child welfare system for this trend, as well as to treat opioid addiction among women of child bearing age.