Prenatal Substance Exposure and Child Protection System Involvement to Age 12 Years

BACKGROUND AND OBJECTIVES Children with prenatal substance exposure are at high risk of child protection involvement during infancy. We quantified the risk and timing of child protection system involvement until age 12 years among children with and without prenatal substance exposure. METHODS A whole-population birth cohort (2007–2018) was assembled from data linked for the New South Wales Child E-Cohort, Australia. The prenatal substance exposure population included children with records indicating prenatal substance exposure in hospital, emergency, mental health outpatient, opioid treatment, and/or child protection reports data. We estimated the risk of child protection responses (screened-in reports, investigations, substantiations, and out-of-home care [OOHC]), and child maltreatment types. RESULTS 1 161 876 children (17 976 with prenatal substance exposure) and 717 063 mothers were included. By age 1 year, 75% of the prenatal substance exposure population born in 2018 had ≥1 screened-in report, 34% ≥1 substantiation, and 20% ≥1 OOHC placement, compared with 4%, 0.8%, and 0.2% of all other children, respectively. By age 12, 90% of the prenatal substance exposure population born in 2007 had ≥1 screened-in report, 61% ≥1 substantiation, and 39% ≥1 OOHC placement, compared with 18%, 5%, and 1% of all other children, respectively. One-half of the prenatal substance exposure population had neglect recorded by age 12. Health and socioeconomic disadvantage were more common among the prenatal substance exposure population. CONCLUSION Children with prenatal substance exposure experienced high child protection involvement early in life. Child protection reports represent an opportunity to mobilize nonstigmatizing substance use in pregnancy and antenatal care to prevent escalating child protection interventions.