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2.2.19 Parental Substance (Drugs and Alcohol) Misuse (including pregnancy)


  1. Recognition of Risk to Child
  2. Importance of Working in Partnership
  3. Referral to Children Specialist Children’s Services (Kent)/Children’s Social Care Services (Medway)
  4. Referral During Pregnancy
  5. Babies Displaying Withdrawal Symptoms/Foetal Alcohol Syndrome/Signs
  6. Further Guidance

1. Recognition of Risk to Child

Parental substance misuse of drugs or alcohol becomes relevant to child protection when it impacts on the care provided to their child/ren.

Substance misuse may include experimental, recreational, poly-drug, chaotic and dependent use of alcohol and / or drugs.

Misuse of drugs and/or alcohol is strongly associated with Significant Harm to children, especially when combined with other features such as domestic abuse, mental illness and personality disorder.

The risk to child/ren may arise from:

  • Use of family resources to finance parents’ dependency, characterised by inadequate food, heat and clothing for children;
  • Exposing children to criminal or other inappropriate adult behaviour;
  • Unsuitable care givers or visitors – e.g. customer or dealers;
  • Being passengers in a car being driven by a driver who has been drinking or using drugs;
  • Effects of alcohol or drugs which may lead to dis-inhibited behaviours e.g. inappropriate display of sexual and/or aggressive behaviour;
  • Chaotic drug use which may lead to increased irritability, emotional unavailability, irrational behaviour and reduced parental vigilance;
  • Withdrawal symptoms including mood disturbances;
  • Unsafe storage of drugs or injecting equipment;
  • Adverse impact of growth and development of an unborn child;
  • Risk to the newborn infant of being born with withdrawal syndrome;
  • Increased risk of the child developing alcohol and drug use problems themselves (and associated risks of unwanted sexual encounters and injuries through fighting / accidents).

Parental non compliance with treatment plans should raise professional concerns about the risk to the children.

2. Importance of Working in Partnership

Partnership working across agencies is vital for effective assessments of risk and to ensure child/ren’s safety and involves:

  • Communication;
  • Sharing of information;
  • Co-ordination of responses.

In accordance with Information Sharing and Confidentiality Procedure of this manual, information about parents with substance misuse problems should be shared with other relevant professionals if there are any concerns about the welfare of the child/ren or for the unborn child.

Care programme meetings regarding drug or alcohol abusing parents must include consideration of any needs or risk factors for the children concerned. Local Authority Children’s Services should be given the opportunity to contribute to such discussions.

Strategy discussions and child protection conferences must include workers from any drug and alcohol service involved with the family.

3. Referral to Specialist Children’s Services (Kent)/Children’s Social Care Services (Medway)

If staff in drug and alcohol services have concerns regarding the care of the child (or unborn baby), they must discuss them with their line manager or supervisor.

A referral to children’s Specialist Children’s Services (Kent)/Children’s Social Care Services (Medway) must always be made when:

  • If there are concerns that a child or an unborn child may be suffering or likely to suffer Significant Harm;
  • Substance misuse is combined with domestic abuse or mental illness;
  • The substance misuse of a parent or carer is chaotic or out of control;
  • Drugs and paraphernalia (e.g. needles) are not kept safely out of reach of children;
  • Where both parents are drug / alcohol abusing, and/or there is a lack of positive social support/network.

If there is any uncertainty about whether a referral is appropriate advice should be sought via a consultation from the Kent Central Duty Team or the Children's Advice and Duty Services (CADS) in Medway via Customer First.

Child care concerns which do not involve child protection can also be referred for advice and support on a child in need basis with the agreement of the parent / carer.

A GP who has concerns and is uncertain about the appropriate action should discuss with the ‘named GP’ or ‘named nurse’ for child protection in her/his locality.

4. Referral During Pregnancy

All professionals working with pregnant women should be familiar with the parts of this manual addressing pre-birth vulnerability. (see Pre-birth Procedures Procedures).

If a professional is aware a pregnant woman or her partner is involved in significant substance misuse, a referral should, if there are concerns about the welfare of the baby during pregnancy or after the birth (see also Pre-birth Procedures Procedures), be made at the earliest opportunity (and no later than the 12th week of pregnancy wherever possible) if any of the following criteria are met:

  • A previous child has been removed or is living permanently with another carer;
  • The woman has been using heroin, methadone, cocaine or comparable substances for a significant period;
  • The woman is continuing to use heroin or misuse methadone and making insufficient preparations for her baby’s arrival;
  • Her use is characterised by multiple drugs / drugs and alcohol;
  • Family’s lifestyle is known or reported to be chaotic and / or unhygienic;
  • Another household member is known or reported to be involved in significant substance misuse;
  • The absence of extended family / friends able to provide extensive support to the substance misusing prospective parent/s.

The midwifery service must initiate a phone and written referral as soon as it becomes aware of concerns relating to substance misuse.

The midwife should ensure Hep B and HIV screening has been recommended to all drug users (Hep C screening is also recommended for intravenous users or for those who are Hep B or HIV+) and that the results are available in the hospital notes (see Pre-birth Procedures Procedures for additional pre-birth procedures that apply in these circumstances).

5. Babies Displaying Withdrawal Symptoms/Foetal Alcohol Syndrome/Signs

Where a baby is born and displays (immediately or later) symptoms of withdrawal or of foetal alcohol syndrome/signs, midwives / paediatric consultant must refer the baby to Local Authority Children’s Services within one working day.

Unless the baby is already the subject of a child protection plan, Local Authority Children’s Services should convene a strategy discussion with Police Public Protection Unit, medical professionals and any other relevant professionals prior to discharge (see also Children Living Away from Home (including Children and Families living in Temporary Accommodation) Procedure and Hospital Pre-Discharge Arrangements Procedure.

This discussion will need to decide and plan:

  • Assessments to be initiated, including whether or not to initiate Section 47 Enquiries;
  • If it is safe for the baby to be discharged / remain at home;
  • Health and Local Authority Children’s Services plans to provide support and monitor progress;
  • Arrangements for notification of discharge from hospital – Local Authority Children’s Services.

6. Further Guidance

See the Medway Safeguarding Children Board website for practice guidance for When Parents Are Misusing Drugs and for When Parents Are Misusing Alcohol.