New York: Children whose parents misuse alcohol or use, produce or distribute drugs face an increased risk of medical and behavioural problems, says a study. "Parents' or caregivers' substance use may affect their ability to consistently prioritise their children's basic physical and emotional needs and provide a safe, nurturing environment," said study co-author Vincent Smith, Neonatologist at Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts. Whether from the toxic effects of exposure to these substances or from the neglect of their basic needs by parents or caretakers struggling with substance use disorders, children in these households commonly experience developmental and educational delays and, later, are at higher risk for mental health and behavioural problems. They also are more likely than their peers to have substance use disorders themselves later in life. In their report, the experts from BIDMC and Boston Children's Hospital reviewed the clinical signs of foetal exposure to alcohol, cannabis, stimulants and opioids. The report appeared online in Pediatrics, the journal of the American Association of Pediatrics. Citing studies that say children whose parents use drugs and misuse alcohol are three times more likely to be physically, sexually or emotionally abused and four times more likely to be neglected than their peers, the authors urged all paediatricians to include questions about caregivers' substance use as part of the routine family assessment. Some warning signs of abuse and neglect include: frequent injuries and bruises, especially in clusters or in patterns that could indicate contact with a hand, belt or other instrument; children who are withdrawn, fearful or flinch at sudden movements; a lack in dental care or immunisation; or ill-fitting, filthy or inappropriate clothing. "Because these children are at risk of suffering physical or emotional harm, paediatricians need to know how to assess a child's risk and to support the family to get the help they need," Smith, who is also Assistant Professor of Paediatrics at Harvard Medical School (HMS), noted. "Because paediatricians are the health care providers most likely to encounter families with young children who may be affected by substance use, they have the opportunity to help break multigenerational cycles of abuse," the authors said.