Caring for Baby with Prenatal Drug Exposure

In our state, all perspective foster and adoptive families are required to complete a checklist of characteristics as part of the home study.  Couples and individuals must determine the “type” of children they are willing to consider.  Questions include: gender, age, race, family history, medical conditions, mental and emotional health, education, personality, behavior, etc.  It’s lengthy and (for us) overwhelming as every possible condition is considered.

One section that seemed particularly intimidating was related to maternal drug use.  The form distinguished between babies born addicted, babies who had positive toxicology screens at birth, and babies with prenatal drug exposure. At our initial licensing, we did not understand the differences. We checked “will consider” to each.

Now, six years later, we are NOT experts by any means but we have learned what works — and what does not — for infants with these birth histories. The first few weeks are very challenging; controlling the environment is critical. 

I no longer hesitate to accept newborns with drug addiction. We can give them a stable, loving start so they’re prepared to return home when it’s time.


We were particularly helped by a handbook developed by PICC. We were trained using their therapeutic handling principles, including baby wearing, swaddling, and controlling environmental stimuli.

I’m a big fan of swaddling for all babies! I love little baby burritos..

I am not qualified to offer medical advice. I do, however, want to offer a few suggestions based on our experience. AND I’d love to get feedback from other foster and adoptive parents on what has worked for you! Please comment below!

For these newborns with difficult backgrounds, the symptoms will vary. The type of drug, the length of use, frequency of use, and the nutrition of birth mother are all factors.  Do research on the particular drug, if possible (resources linked below).


Signs and Symptoms might include:

-tremors /jitteriness

-pronounced Moro reflex (feeling of falling when the baby throws arms out and stiffens to support self)

-increased muscle tone

-sometimes difficult to comfort and settle

-over-active and agitated

-severe colic

-sensitivity to light (hiccuping, sneezing and frequent yawning are signs of over-stimulation)! This can be the biggest tip off that you need to reduce stimuli.

-exaggerated sucking reflex

-loose stools

Finnegan Scoring System is used to assess these babies before discharging home with caregiver. Many are treated with morphine while withdrawing. Ask your hospital about your newborn’s score. (Our local hospital requires score of less than 8 every 4 hours prior to being discharged.)


Tips for Caregiver:


-wear baby in wrap or carrier close to parent’s chest (frequent skin to skin contact is great too)

-offer pacifier

-dim lights at home

-reduce noise and fragrances in the home (we are SO GRATEFUL when our friends do not wear perfume or scented lotion)

-hold baby in “C position” (bend knees upward toward chest and curl back forward slightly)

-soothe baby by moving him up and down (vertical rock) in head-to-toe movement (keep baby swaddled and in C position); some babies like to be in a swing but bouncers are often too stimulating




Toolkit for Children Prenatally Exposed; distributed by Macomb Intermediate School District. I found the chart most helpful.

Pediatric Interim Care Center (PICC), (their handbook was helpful or try these therapeutic handling tips!)

The Happiest Baby on the Block

The Nature of Nurture : Biology, Environment, and the Drug-Exposed Child


– – – –

Elaine and her husband are licensed as an adoptive family and foster home.






One thought on “Caring for Baby with Prenatal Drug Exposure

Comments are closed.