Not every newborn is tested for drugs and some do not initially show signs of drug exposure, so it is impossible to say how many drug babies are born each year.
"Hospitals are not legally mandated to report a positive toxicology screen, so we've always felt there was just a percentage that came to our attention," says Mary Harris, program analyst for the Orange County Social Services Agency.
Cheryl Milford, assistant clinical professor of pediatrics at UC Irvine Medical Center, says most babies exposed to opiates, such as heroine and methadone, go through physiological withdrawals.
Babies exposed to stimulants such as cocaine and amphetamines may have tremors, feeding problems or sleeping problems, but do not go through a life-threatening withdrawal.
She says the majority of drug-exposed babies "probably are not going to show any significant difficulties like retardation. We don't know in terms of the more subtle things, like behavior problems or mild learning disabilities. Nobody's been able to follow them that far yet, but those studies are in progress right now, of which we are one."
Social Services' Harris says some hospitals either have no protocol or they have varying policies for testing drug babies. "Or, they might test a baby and determine that things otherwise look OK," she says. "The hospital and the (mother's) doctor make the decision whether or not to test and what to do once they have tested."
As required by law, an emphasis is placed on trying to keep the mother and baby together to maintain the parent-child relationship, she says.
Harris says the services of a social worker are offered if the parents are cooperative and if it is determined that intervention will reduce the risk of abuse or neglect to the baby.
The condition of the baby is also part of the decision-making process, Harris says. "It's difficult when we don't see all the symptoms right away, because then everyone is left not sure of what special needs the child will have."
If it is determined that the baby would be at risk even with all available services to the parents, the social worker would ask for a legal order to prevent the hospital from releasing the baby. Harris says that any time Social Services places a hold on a baby, a detention hearing will be scheduled within 48 hours. "If we wish to continue protective custody, we must file a petition (with juvenile court to give Social Services legal authority in the situation)."
Harris says three things can then happen: "The court can dismiss our petition, they can return the baby to the parents and order us to supervise, or they can order the baby to be placed in foster care."
Harris believes that the Perinatal Substance Abuse Act, legislation recently passed by the state, may have a negative impact on the number of drug babies reported to the Child Abuse Registry.
The legislation says that a positive toxicology screen at the time of a baby's delivery is not in itself a sufficient basis for reporting child abuse or neglect.
"So it places the responsibility of doing a more in-depth assesment--of the mother's situation, of the child's special-care needs and the risk of neglect or abuse of the child--on the hospital personnel," Harris says.
"I think that if hospitals had been already spending the time to consider all the circumstances, that it (the legislation) should not make any difference.
"But I'm concerned that other hospitals will not have the time or the interest to work with families on this and, as a result, they simply will not receive any services."