When a toddler in Sheffield died last year from drinking methadone, it was a sharp and shocking indicator of just how vulnerable young children are to the dangers of living with drug-addict parents.
While methadone is a frequently prescribed, and often effective treatment, for heroin withdrawal, it has all the appearance of cough mixture and can be fatal if a child gets hold of it.
'Safety in the home is just one aspect of an escalating problem,' says Alex Bennett, co-ordinator at Sheffield Family Centre. 'It is ignorance on the part of some addict parents, who don't realise the danger of leaving their drugs and medication around where children can reach them - often in containers that are not child-proof.'
The urgent need to minimise these kinds of risks and the many others associated with drug abuse are now being more forcefully addressed by the Government, social services and other agencies.
The Government's Drugs Action Plan identifies the children of drug misusing parents as a priority group. Good Practice Guidance, in a recent report from the Advisory Council on the Misuse of Drugs entitled Hidden Harm: Responding to the needs of children of problem drug users (see Further information), provides practical advice for carers about working with families affected by these problems.
Drug Action Teams and Area Child Protection Committees are also now required to have local policies in place to support families.
However, for those working in nurseries and other childcare settings, the situation continues to represent an enormous challenge.
Hidden harm
The statistics are chilling. According to the Hidden Harm report, there are up to 300,000 children living in homes in England where parents have serious drug problems, while in Scotland the figures are even higher.
The adverse effects on children of drug-using parents are wide-ranging, and vary according to the stage of the child's development.
At a young age, they can include failure to thrive, blood-borne virus infections, incomplete immunisation and the general effects of inadequate health care. Children may also experience a range of emotional, cognitive, behavioural and psychological problems, including early substance misuse, offending behaviour and poor educational attainment.
'It is a huge problem which the Government is just beginning to properly respond to,' says Mark Lee, policy officer, substance misuse and drugs, for children's charity Barnardos.
'Nursery and daycare workers are on the frontline, and the aim is to have more support services available to them,' he says. According to Mr Lee, the difficulty arises when trying to identify a child who is having to cope with the effects of parental substance misuse at home - whether it be drugs or alcohol.
'They may manifest in difficult behaviour or signs of neglect, or they may be drawing pictures of syringes,' he says. 'Nurseries need to have policies in place to enable them to recognise the signs and to quickly do something about them.'
A big part of the problem is getting parents to come forward and admit they have a problem. 'Just because they are using drugs it doesn't mean they are a bad parent,' he says. 'But there is a need for them to address what is happening without being too fearful of the consequences.'
Working together
At the Sheffield Children's Centre, chair Chrissy Meleady works with parents and children, individually and collectively, with a range of agencies, including local drug rehabilitation centres, social services, the NSPCC, police and voluntary agencies.
She confirms an increase in the problem in all areas and across all levels of society. She believes it is important to tackle the problem at the earliest possible stage in a child's life.
'We have had families who have maintained family structures and also those who have gone into homes. In many cases, the families have eventually come off drugs, which is very encouraging.
'Of paramount importance is the personal safety of the child. In extreme situations, they may pick up needles, and one of the biggest killers is sniffing substances. To combat these problems, there needs to be a concerted effort with training - not just in inner cities - but nationwide.
There also needs to be extra support and guidance.'
At the Sheffield Family Centre, Ms Bennett believes the monitoring of children should be vigilant. 'It is a case of knowing when parents have moved from recreational use of drugs to the dependency stage,' she says.
'Nursery workers should be able to identify whether a child's behaviour has changed. It could be he or she becomes withdrawn and finds it difficult to form relationships, or becomes hyperactive. Often children suffer from a lack of routine.'
Ms Bennett emphasises that the worst case scenario is when home life completely breaks down. 'This is when the family is out of a home and all the money is being spent on drugs,' she says.
'However, there are lots of cases that are not as severe and, wherever possible, it is important to work closely with parents and bring out their potential to be good parents.'
June O'Sullivan, operations and training manager at Westminster Children's Society, says that when it comes to the child, the issue is more often one of mental, rather than physical, health.
'It is unquestionably becoming a bigger problem,' she says. 'It is the lifestyle that goes with drug-taking in the home that is often a concern.
In one of our nurseries, carers had to deal with the child of a mother who was herself abused, and it is an ongoing process of trying to monitor what the child is being subjected to.'
Be pro-active
Ms O'Sullivan says that childcare practitioners should try to ensure parents and children in these situations have a relationship with social services, and play a part in the monitoring process.
'More often it is a case of tackling neglect, rather than abuse,' she says.
Undoubtedly, the Government's new initiatives provide a tighter framework for nursery workers and carers to be more pro-active in the business of helping children.
Ms O'Sullivan corroborates this. 'It simply is not possible to remove all the children from their home situations, so there have to be more structured ways to improve their existing home life.
'It is often a delicate balancing act between individual monitoring and working with outside agencies,' she says.
The advice to those working with young children is not to minimise any concerns, and to record as much information as possible. Nurseries have a responsibility to pass on information to social services where they identify there is a problem, albeit it in a confidential way.
Mark Lee, from Barnardos, says, 'Nurseries and the individuals who work in them need to have policies in place so they know what to do when this kind of situation arises.'
He adds, 'It is going to take more work at a senior level to strengthen the links between daycare situations and outside agencies, but only by working together more easily and effectively can children receive the care and protection they so desperately need.'
FURTHER INFORMATION
* Hidden Harm: Responding to the needs of children of problem drug users can be downloaded from www.homeoffice.gov.uk.
A hard copy of the report can be ordered online, or by calling Prolog on 0870 2414680.
CASE STUDY
Single mother Claire Lewis* was already trying to break her heroin habit when the nursery her four-year old son attended expressed its concerns about his behaviour.
Tom was hyperactive in class and frequently destructive, tearing up books and destroying toys. When asked about home, he would only talk about his 12-year old brother, who seemed his main carer and often picked him up from nursery.
'I have always managed to hold down a job, but I was finding it difficult to keep track of organising and supervising Tom's life properly,' says Claire. 'A lot of this responsibility fell to his older brother Luke, who had become extremely protective of both him and myself.
'I could see that this burden of responsibility on my older boy was having a very negative effect on him. He had become very shy and withdrawn, and was playing truant from school all the time.
'I was referred to my local drug rehabilitation centre and tried a course of methadone, but I didn't respond to this at all. In the end, I found that counselling and alternative therapies, including acupuncture, provided more effective treatment.
'Ultimately, the desire to be a better parent - for both boys - was my biggest motivating factor. I feel things are moving forward now and I am more involved in Tom's life. I know how important it is to spend time with him and focus on his needs, so that he does not suffer from neglect in any way.
'And that means much more than just ensuring he is properly clothed and fed.'
*Not her real name