The biggest problem for babies exposed to methamphetamine during pregnancy is how beautifully ordinary they look.
- Methamphetamine is now the primary drug of choice detected in pregnant women
- Children exposed in utero don't show clear signs of a problem as babies
- But as they mature, the subtle symptoms can easily be missed or misdiagnosed
While babies addicted to opioids show the jittery signs of immediate withdrawal, methamphetamine-affected babies show little more than a tendency to sleep.
Neonatologist Ju Lee Oei said not only were these babies often overlooked at birth, it was not until they approached school age that concerning behavioural and learning issues really started to emerge, by which time years of treatment opportunities had been missed.
"There is huge concern about the subtle effects of methamphetamines," said Dr Oei, who is also a conjoint professor at the University of NSW.
"You don't necessarily have a child with overt cerebral palsy or disability, but they have a lot of attention, behavioural and subtle cognitive losses that cannot be explained by anything else after you take away the lifestyle, environmental differences and genetic influences."
She said while it was clear methamphetamine was neurotoxic — damaging to nerves or nervous tissue — research was only just beginning to identify its potential long-term effects.
Methamphetamine the new 'epidemic'
Dr Oei said she believed a fear of stigmatising these mothers and their children had led to resistance in funding vital research, such as brain imaging.
"A lot of the policymakers are consumed with opioid use," she said.
"But I think methamphetamine is potentially a much bigger issue. It's easier to get, it's cheaper and it is much more damaging to the child.
"It needs to be as big as or even bigger than FASD (Foetal Alcohol Spectrum Disorders). Everyone knows FASD, it's been around forever, but methamphetamine is a new epidemic."
Unless the mother admits to taking methamphetamine, Dr Oei said it was difficult to identify babies as being at risk — she predicted up to 90 per cent went undetected.
"The trouble is there are no physical signs and a lot of medicine and policies work on physical symptoms," Dr Oei said.
"Methamphetamine babies are usually what we call the 'very good babies', they sleep a lot and they just fly under the radar. No-one knows that they are there.
"There are no guidelines for their management or their support, or any intervention."
On top of that, a proportion of babies are placed in out-of-home care, where carers are unaware of the drug exposure.
"The trouble is we don't have data to show what problems they face after they go home because we can't find them," Dr Oei said.
"If you use methadone, everyone is all over you.
"You get all the services, all the support that you need, but if you use methamphetamine and you feel OK a day or so after birth, off you go."
The most significant study done to date, known as the IDEAL study, has followed hundreds of babies exposed to methamphetamine in New Zealand and the United States since 2005.
It found delays in cognitive development, most significantly in boys.
"We know we can't stop a lot of prenatal exposure, but can we do anything to help these children recover if they have been damaged before birth?" Dr Oei said.
The children falling between the cracks
Stacy Blythe is a nurse, long-term foster carer and an academic.
Her first-hand experience having previously cared for children who have been exposed to substance abuse during pregnancy drove her into researching this field.
"Generally what would happen is the child presents as relatively healthy and they continue to grow and develop," Dr Blythe said.
"But when they get behaviourally to four or five years old, their behaviours may look like those of a two- or three-year-old because the higher-order areas of the brain haven't developed chronologically at the same rate."
She said drug exposure could interfere with the child's working memory and their ability to control impulses and think flexibly.
This perceived "change" in behaviour when the child reached school age was confusing for carers, particularly kinship or foster carers now looking after the child.
"If a carer is uneducated and they don't understand there is actually a neurologic disability occurring, they can use disciplinary methods that would potentially actually make the situation worse," Dr Blythe said.
"If you don't understand what is happening in the child's brain and why the behaviours are there, then it is really difficult to parent them in a way that is therapeutic and helpful."
Dr Blythe has now developed a training program for carers to help them recognise these behaviours and provide management strategies.
"I have experienced a number of carers in tears. Because of the information I give them they say, 'You are describing little Joey exactly and I didn't know and I have been doing it wrong'.
"They are devastated."
Dr Blythe said many of those children "fell between the cracks" in accessing therapies and educational services because they did not fit a known diagnosis.
Instead, they might be labelled as having autism, ADHD, reactive attachment or oppositional defiance disorders.
"It's an unfortunate situation where a child has to be labelled to get the assistance they need," Dr Blythe said.
"In this case they need to be mislabelled in order to get any assistance."
Dr Blythe said the child's development was not just affected by substance exposure, but also elevated levels of cortisol from trauma both in utero and early development, which could also impair brain development.
She believed current treatments were "band-aid" solutions.
"There certainly needs to be a whole lot more early intervention," she said.
"We need to remember these children are innocent victims. If we don't invest while they are growing up, we are going to be supporting them as adults and we are going to be supporting their children."
WA develops diagnostic tool
Every year about 250 women are referred to King Edward Memorial Hospital's Women and Newborn Drug and Alcohol Service (WANDA).
The service typically sees heavier users, and for the past 10 years methamphetamine has been this group of women's primary drug of choice.
Service coordinator Angela O'Connor is developing guidelines to help staff specifically manage infants withdrawing from methamphetamine.
"What we do know from our own observations is that our babies, they don't do the normal standard withdrawal that [they] need to go to the nursery," Ms Blythe said.
"They often are small, they can have smaller head circumferences, they can be a bit sleepy post-birth and they might take a bit longer to gain weight."
The most significant aspect of the new guidelines will be ensuring the baby is feeding and gaining weight.
The infant will also continue to be followed up for at least three months.
Ms O'Connor agreed methamphetamine was a public health crisis — not just for children but also families and communities — but added that developmental issues in babies could not be attributed to the effects of methamphetamine alone, but also additional factors such as poverty and domestic violence.
"Sure these infants are at risk for developmental delay, we would never say otherwise, but we have to put that in the framework of the other things that are going on, the mental health issues for example," Ms Blythe said.
She said even if women did not disclose their methamphetamine use during pregnancy, she believed staff were skilled at picking it up.
"We do an awful lot of education with our GPs, we do teleconferencing say to our communities up north, we try and put as much support in so women will be referred to care," she said.