Infants who have been exposed to smoked cocaine, or crack, during pregnancy typically show a wide spectrum of symptoms after birth, although it is not uncommon for some infants to be asymptomatic, says the National Institute on Drug Abuse. At first, many infants appear irritable. After this period, they tend to show signs of hypo-reactivity and do not interact much with their caretakers. Infants may also show difficulties following a moving object with their eyes, and some babies develop seizures. The treatment for crack cocaine addiction should be started right after birth.
The first step in any treatment plan should always be an assessment. A good place to start is with a behavioral evaluation. The Brazelton Neonatal Behavioral Assessment Scale is suitable for assessing the effects of cocaine exposure in infants who are up to 2 months old. This scale evaluates different areas of infant development. For example, it shows how an infant responds to such stimuli as a rattle, voices, faces and light. It also determines how well an infant can maintain or alter his stages from sleeping into alertness. This scale also shows whether an infant is typically irritable or not and what his neurological and motor development level is.
It might also be necessary to investigate possible central nervous system abnormalities with neuroimaging tools, says the U.S. Department of Health and Human Services. Although such assessment is not necessary for every infant, babies who show signs of central nervous system abnormalities should be studied using such imaging tools as magnetic resonance imaging (MRI). For example, small head circumference and seizures indicate that the infant might have brain related problems.
Most cocaine-exposed infants do not need any medication, but if the infant is excessively irritable, she may benefit from a short course of phenobarbital. In most cases, this medication is only needed for a few days. When the infant feels better, the medication can be stopped without tapering. Many infants experience seizures following exposure to cocaine and may need a seizure medication such as intravenous phenobarbital.
Optimal Nursery Environment
Cocaine-exposed infants tend to be unresponsive toward social stimuli. That is why it is essential to provide them with an individualized program of structured physical contact, soft social talking and eye contact. Infants should be handled by as few caretakers as possible. Since bright light and loud noises might be irritable for the infant, they should be avoided. Further, many cocaine-exposed infants have feeding difficulties. Thus, nursery personnel should carefully monitor feeds to be certain the infant is getting enough nutrition to ensure healthy growth and development. Breastfeeding is contraindicated if the mother is using cocaine. Cocaine passes to the infant through breast milk and may produce seizures, hypertonia and apnea. Parents should be involved in the infant care as much as possible.
- National Institute on Drug Abuse: Medications Development for the Treatment of Pregnant Addicts and Their Infants
- Journal of Pediatric Psychology: Frequency of Maternal Cocaine Use During Pregnancy and Infant Neurobehavioral Outcome
- "Neonatal Behavioral Assessment Scale, Second Edition"; T. B. Brazelton; 1984