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Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. 285-293 (doi:10.1542/peds.2008-0576)
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ARTICLE

Child Protection Outcomes for Infants of Substance-Using Mothers: A Matched-Cohort Study

Andrea McGlade, MBBS, FRACP, MPHa,b, Robert Ware, PhDb, Maree Crawford, MBBS, FRACPa

a Child Advocacy Service, Royal Children's Hospital, Brisbane, Australia
b School of Population Health, University of Queensland, Brisbane, Australia

OBJECTIVE: Parental drug use is a critical public health issue; it is estimated to be present in up to 80% of referrals to Australian child protection agencies. However, no data regarding the child protection outcomes of infants of substance-using parents exist in Australia, and no comparisons have been made with infants of non–substance-using parents. We assessed differences in substantiated abuse between 2 groups of mothers in Brisbane to quantify this risk.

METHODS: Mothers who disclosed opiate, amphetamine, or methadone use between 2000 and 2003 were identified and compared with non–substance-using mothers who were matched for gender and gestational age. All infants were linked to the Department of Child Safety Child Protection Information System database. Child protection outcomes, such as substantiated notifications and entry into foster care, were compared between groups.

RESULTS: We studied 119 infants of substance-using mothers and 238 matched infants. Infants of substance-using mothers were more likely to suffer substantiated harm (hazard ratio 13.3 [95% confidence interval 4.6–38.3]) and to enter foster care (hazard ratio 13.3 [95% confidence interval 5.1–34.3]). Infants of mothers using illicit drugs were more likely to suffer substantiated harm and more likely to enter foster care than infants of mothers who were compliant with a methadone program.

CONCLUSIONS: Infants of substance-using mothers have much poorer child protection outcomes than infants of non–substance-using mothers. This study adds substantial evidence toward a real association between maternal drug use and child abuse. Greater interagency collaboration is urgently required to reduce this risk.

Key Words: child advocacy • prenatal exposure • substance abuse/use • public health

Abbreviations: DChS—Department of Child Safety • RBWH—Royal Brisbane and Women's Hospital • CCD—census-collection district • CPO—care and protection order • HR—hazard ratio • CI—confidence interval • SES—socioeconomic status

Accepted Nov 18, 2008.


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