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Infants in the Child Welfare System: Exposure and Risks of Parental Alcohol and Drug Misuse

Lindsey Palmer1, Sarah Font2, Julia Reddy3

  • 1College of Social Work, University of Utah, 395 1500 E, Salt Lake City, UT, USA. Lindsey.N.Palmer@utah.edu.

Maternal and Child Health Journal
|March 26, 2025
PubMed

Insights

Parental alcohol and drug misuse (PADM) is prevalent in infant child welfare cases. Infants remaining at home after PADM exposure face higher risks of subsequent physical harm, including severe injuries and head trauma.

Area of Science:

  • Child Welfare Research
  • Pediatric Health
  • Substance Use Disorders

Background:

  • Parental alcohol and drug misuse (PADM) significantly impacts child welfare systems.
  • Infants exposed to PADM face elevated risks of harm and require targeted interventions.

Purpose of the Study:

  • To determine the prevalence of PADM in initial and subsequent child welfare cases.
  • To evaluate the risk of injury in infants exposed to PADM.

Main Methods:

  • Utilized linked Medicaid and child welfare system data in Pennsylvania for children born 2016-2018.
  • Employed survival analyses and Cox Proportional Hazard models to assess injury risks in infants remaining at home post-PADM exposure.

Main Results:

  • PADM was present in 64% of infants' initial child welfare cases.
  • Infants with PADM remaining at home showed increased risk for physical harm, severe harm, and head injuries compared to those entering care.
  • No significant differences in harm outcomes were found between infants with and without medically diagnosed prenatal substance exposure.

Conclusions:

  • Current 'plans of safe care' for substance-exposed infants are limited by identification challenges and inadequate public health response.
  • Coordinated strategies are essential for the prevention, detection, and treatment of parental substance use disorders to protect infants.
Abstract

Keywords:
Child abuse and neglectChild maltreatmentParental substance abusePhysical injuriesPrenatal substance exposure

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