Australian hospitals lack standardised developmental screening for infants exposed to prenatal alcohol and drug use

A new survey reveals most Australian hospitals do not utilise formal developmental assessment tools for infants exposed to alcohol or drugs before birth, highlighting gaps in follow-up care and an urgent need for standardised guidelines.

A new Australian survey has found that most hospitals caring for infants exposed to alcohol or drugs before birth do not use formal developmental screening tools, leaving follow-up care for this high-risk group fragmented and inconsistent. The research, published in the Journal of Paediatrics and Child Health, is presented as a first national benchmark of how neonatal services monitor babies and toddlers aged 0 to 2 years who were exposed to alcohol and/or drugs in utero.

The findings matter because prenatal exposure to alcohol and other substances is associated with an elevated risk of neurodevelopmental difficulties, learning problems and later physical and mental health challenges. The Centres for Disease Control and Prevention says fetal alcohol spectrum disorders can have lifelong effects, while broader reviews of prenatal drug exposure have linked it to long-term changes in brain development. Earlier intervention has also been shown to help some substance-exposed infants, particularly when families face greater social risk, according to research published in JAMA Pediatrics.

In the Australian survey, 15 hospitals responded out of 43 invited, with services in Victoria, New South Wales and Queensland represented. Most respondents said infants exposed to alcohol or drugs were seen within routine neonatal care rather than through a dedicated programme. Only a minority reported targeted follow-up, and just one in three said they used any developmental screening or assessment tool at all. Where follow-up did occur, it often took place only when concerns arose, rather than on a fixed schedule.

The tools and pathways in use varied widely. Some services relied on general developmental observation, while others mentioned the Bayley Scales of Infant and Toddler Development, the Ages and Stages Questionnaire, Finnegan-based withdrawal scoring or the General Movement Assessment. Many services said allied health professionals such as physiotherapists, occupational therapists and speech pathologists were involved only when medical staff identified a need, for example because of feeding problems, abnormal movement, withdrawal severity or other clinical concerns. In many cases, referrals were handled internally through hospital systems and were not built into a structured care pathway.

Funding emerged as the biggest obstacle. Most of the hospitals that answered the survey said they had no dedicated money for this type of follow-up, and staffing shortages were also frequently cited. The researchers argued that this leaves a vulnerable group dependent on uneven local practice, despite evidence that infancy is a period of high neuroplasticity when screening and intervention can make a difference. They said the results point to an urgent need for standardised guidelines, better validated assessment tools and clearer multidisciplinary pathways so that developmental concerns can be identified earlier and support can begin sooner.