Pediatric primary care clinicians’ views on needs and challenges in caring for infants with intrauterine opioid exposure and their families

Abstract

Opioid use disorder (OUD) during pregnancy has risen in the U.S. over the past two decades, resulting in a growing number of children with intrauterine opioid exposure (IOE). Limited research exists supporting best practices to optimize primary care for these children and their families, particularly mothers with OUD. Using a modified Delphi method, we surveyed pediatric primary care clinicians from a single children’s health care system regarding their experiences in caring for this population. In Phase 1, open-ended survey questions inquired about needs and challenges facing these infants, their families, and clinicians and resources within primary care. After thematic analysis, the most frequent responses were presented as a Phase 2 survey for clinicians to select their top five. Percentages for the most commonly selected top five themes were tabulated. Survey response rates were 58/139 (42%) for Phase 1 and 45/137 (33%) for Phase 2. For infants with IOE and their families, respondents identified parenting knowledge and family issues related to maternal OUD as top challenges, with limited resources to address them in primary care. Clinicians identified time constraints and follow-up issues as top challenges. Future intervention in pediatric primary care could include addressing parenting education, resource gaps, and best practice recommendations in caring for children with IOE.

Priorities for Well Child Care of Families Affected by Parental Opioid Use Disorder

“…Maternal OUD recovery was raised as a potentially salient topic, but clinicians and mothers expressed varying comfort discussing this during WCC visits. This is consistent with other studies suggesting that mothers with OUD are often worried about being judged or blamed, and that pediatricians often lack knowledge about or connection to OUD treatment programs 27,32 . Currently, there are no training requirements for pediatric clinicians to learn about treatment of substance use disorders in adults and how this may impact pediatric patients, although the American Academy of Pediatrics has begun collating some online informational resources 7…”

“…For children of mothers with OUD, the impact of poverty cannot easily be disentangled from the impact of prenatal opioid exposure, and methodologically, the issue of psychosocial and environmental confounding is a near-constant threat to any research on outcomes for this population 25,26 . Recent studies support the notion that conditions associated with poverty—that is, housing instability, transportation difficulty, social isolation, educational attainment, and caregiver stress—are key drivers of health and healthcare disparities for children affected by maternal OUD 12,27 …”

“…25,26 Recent studies support the notion that conditions associated with poverty-that is, housing instability, transportation difficulty, social isolation, educational attainment, and caregiver stress-are key drivers of health and healthcare disparities for children affected by maternal OUD. 12,27 However, the stigma and bias surrounding maternal OUD are specific to this patient population and likely permeate their experiences of healthcare including pediatric visits. 6 Even after adjusting for poverty, children with prenatal opioid exposure are less likely to receive recommended WCC.…”

“…This is consistent with other studies suggesting that mothers with OUD are often worried about being judged or blamed, and that pediatricians often lack knowledge about or connection to OUD treatment programs. 27,32 Currently, there are no training requirements for pediatric clinicians to learn about treatment of substance use disorders in adults and how this may impact pediatric patients, although the American Academy of Pediatrics has begun collating some online informational resources. 7 Lastly, mitigating child safety concerns was emphasized as a priority by clinicians, but less so by mothers.…”

Group Well Child Care for Mothers with Opioid Use Disorder: Framework for Implementation

“…Parents with OUD have reported their WCC experiences as lacking key aspects of family centeredness such as open communication and personalized care (Short et al, 2019 , 2022 ). Simultaneously, pediatricians report a lack of time and resources to comprehensively address their questions and psychosocial needs (Rohde et al, 2023 ).…”