AAP: Pediatricians Can Help Support Children and Families Affected by Parental Substance Use

Pediatricians urged to build on trusted relationships and support well-being of entire family. 

ITASCA, IL -- About 1 in 4 U.S. children live in a home with an adult who has a substance use disorder. These children face risks to their health and development, both from direct exposure and from potential effects on caregiving and the home environment. 

In an updated clinical report, the American Academy of Pediatrics urges pediatricians to support the well-being of children and other family members affected by parental substance use. The clinical report, “Children and Families Affected by Parental Substance Use,” published in the December 2026 issue of Pediatrics, emphasizes a nonjudgmental approach grounded in trusted relationships. 

Published online Oct. 26, the report broadens the focus of prior related AAP policies. It addresses medical assessments of infants and children whose parents have a substance use disorder; the appropriate use and interpretation of toxicology testing to guide clinical management; and collaboration with pediatric medical specialists, child welfare professionals, and community resources. 

“Families don’t experience substance use in a vacuum. Bias, racism, and stigma shape who receives support and who faces punishment,” said Davida M. Schiff, MD, MSc, FAAP, lead author of the clinical report, written by the AAP Council on Child Abuse and Neglect and Committee on Substance Use and Prevention. 

“These disparities can influence involvement with the child protection and criminal legal systems and can erode trust in health care and public systems. The most effective approach focuses on meeting families where they are, using respectful, nonjudgmental communication and providing anticipatory guidance to promote child safety,” said Dr. Schiff, a pediatrician and director of Perinatal and Family-based Substance Use Disorder Care at Mass General Brigham for Children. 

Pediatricians are encouraged to use toxicology testing only when they will change clinical practice, provide clear guidance about risks such as unsafe sleep and accidental ingestion, and coordinate care with community and child welfare partners.

The clinical report discusses how prenatal and postnatal substance exposure are associated with developmental, cognitive, and behavioral risks. Yet these outcomes are influenced by many factors, including poverty, co-exposures and the caregiving environment, making it difficult to isolate the effects of substance exposure itself.

“Pediatric clinicians are often among the first professionals to recognize when parental substance use may be affecting a child's health, safety, or development. Early identification and supportive intervention can help reduce risks, strengthen families, and improve outcomes for children,” said Karen Farst, MD, co-author and chief medical officer at Arkansas Children’s Hospital and member of the AAP Council on Child Abuse and Neglect. 

The AAP recommends that pediatricians: 

• Learn how to assess and address risks to children when a parent uses substances. Routinely talk with families of infants and young children about unsafe sleep, accidental poisoning, abuse, neglect and developmental delays.
• Recognize that systemic discrimination has unfairly affected families of color and the care they receive when substance use is involved.
• Create a welcoming care environment. Use respectful, supportive language and work with families in ways that build trust and give them a voice in decisions.
• Provide consistent care and work closely with other health care professionals, especially when child protective services is involved.
• Use plans of safe care, also called family care plans, to connect parents and children affected by substance exposure during pregnancy with needed services and support.
• Use drug testing only when the results will help guide a child’s medical care, and consider the results alongside other clinical information. A positive test alone does not prove that a parent has a substance use disorder or is unable to care for a child safely.
• Teach parents and caregivers how naloxone can safely reverse an opioid overdose and save a life.

Pediatricians are encouraged to discuss parental substance use as early as possible, including during the prenatal period, to help reduce the risk of negative outcomes for children. 

“Pediatricians can help keep children safe while treating parents with dignity and connecting the entire family with care,” Dr. Schiff said. “When families are met with compassion rather than judgment, we can build trust, reduce harm and create a stronger path toward health and recovery.” 

Other co-authors of this clinical report are Nancy D. Kellogg, MD, FAAP, and Vincent C. Smith, MD, MPH, FAAP. 

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.