Table 6.
The role of the pediatrician in the care of the mother with an opioid use disorder as part of an at-risk dyad
| Recommendation | Things to Consider | Actions |
|---|---|---|
| Think outside of the box | Consider the mother and her unique needs | Refer to comprehensive OUD treatment program that will accept the infant’s presence, if needed |
| Refer for trauma informed care, if warranted | ||
| Refer for psychiatric care, when warranted | ||
| Consider the environment in which the dyad resides | Discuss the needs of significant others (eg, substance use disorder treatment) and physical needs of the mother (eg, legal, housing, etc.) | |
| Provide multidisciplinary care, which is the gold standard for opioid-exposed dyads | Discuss dyadic care with obstetric providers Discuss the dyad with substance use treatment providers, if present (with maternal written consent) |
Ensure appropriate postpartum care, including contraceptive services, if desired All women on methadone or buprenorphine for OUD treatment have an addiction treatment provider and a written care plan. Discuss necessary and specific care of the infant as part of comprehensive care for the mother |
| Beware of overtly or covertly undermining dyadic attachment and communication, both within the dyad and with caregivers | Recognize that language and terms used are important | Avoid use of stigmatizing terms such as “addicted newborn,” “NAS baby,” “methadone baby,” “withdrawal baby,” “if your baby were a normal baby,” etc. All of these terms are pejorative and can negatively affect the interest of the mother with OUD to seek and engage in necessary medical and psychosocial treatment for herself and her infant |
| Provide trauma-informed care | Be aware that sexual, physical, and emotional trauma are common in women with OUD and are often not diagnosed before delivery | Refer for specialized psychiatric care as soon as a history of trauma is suspected |
| Modify the environment and care to assure the comfort of the mother based on her unique experiences. This may include only female nursing staff, no nighttime visitors, being aware of exposing the mother’s body, avoiding standing IVs that “tether” her to the bed | ||
| Recognize that there may be obstacles to breastfeeding,45 including early cessation46 | ||
Abbreviation: IV, intravenous.