Baby Steps Clinic

Moving Forward One Step at a Time

Baby Steps LogoThe Baby Steps Clinic is for families who have a child exposed to substances before birth, which can influence growth, development, learning, and behavior. We know families want the best for their child, and the Baby Steps Clinic can help by offering support, assessment, and interventions. The clinic is here to help every child reach his or her full potential and to support families as they support their child’s development. The Baby Steps Clinic is also recognized as a Promising Practice by the American Academy of Pediatrics. In May 2023 Dr. Dianna Puhr, Medical Director for Baby Steps, spoke on Improving Care for Children & Famlies Affected by Substance Use for the ETSU Child and Family Health Institute Collaborative Series.

Baby Steps Interprofessional Team:

  • Care coordinator
    • The care coordinator follows your family from pregnancy through early childhood helping to track progress, schedule appointments, serve as the point person for questions, make referrals to other services, and help you navigate aspectes of your child's medical, developmental, and emotional needs.
  • Audiologist
    • The audiologist will use age-appropriate objective tests like tympanometry, otoacoustic emissions (OAE) and/or auditory brainstem responses (ABR) to assess your child's entire auditory system from the eardrum to the auditory brain. The audiologist will also ask about your child's listening behavior at home.
  • Speech-language pathologist
    • The speech-language pathologist (SLP) will play with your baby, talk with you, and use age-appropriate tests during your visit. SLPs help babies develop their listening, sound-making, talking, social, play, and feeding skills.
  • Occupational therapist
    • The occupational therapist (OT) will assess your child’s sensory, social, play, and daily living skills by watching your child. The OT will ask how your child sleeps, eats, plays, and learns at home, in child care, or at school.
  • Physical therapist
    • The physical therapist (PT) will observe how your child moves while playing and look for muscle stiffness. The PT will help you to support your child in learning to move, calming himself or herself, and playing to get stronger with better balance
  • Registered dietitian
    • The registered dietitian (RD) will evaluate your baby’s growth and nutrition. The RD will assess your child's nutritional needs and make suggestions for healthy growth.
  • Board-certified pediatrician

 

  • Selected References

    Reddy UM, Davis JM, Ren Z, Greene MF; Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes Workshop Invited Speakers. Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes: Executive Summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Maternal-Fetal Medicine, Centers for Disease Control and Prevention, and the March of Dimes Foundation. Obstet Gynecol. 2017;130(1):10-28. doi:10.1097/AOG.0000000000002054 

    Sweet MA, Appelbaum MI. Is home visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children. Child Dev. 2004;75(5):1435-1456. doi:10.1111/j.1467-8624.2004.00750.x 

    Michalopoulos, Charles, Kristen Faucetta, Anne Warren, and Robert Mitchell. Evidence on the Long-Term Effects of Home Visiting Programs: Laying the Groundwork for Long-Term Follow-Up in the Mother and Infant Home Visiting Program Evaluation (MIHOPE). OPRE Report 2017-73. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. 

    Homer CJ, Klatka K, Romm D, et al. A review of the evidence for the medical home for children with special health care needs. Pediatrics. 2008;122(4):e922-e937. doi:10.1542/peds.2007-3762 
    Paradis HA, Sandler M, Manly JT, Valentine L. Building healthy children: evidence-based home visitation integrated with pediatric medical homes. Pediatrics. 2013;132 Suppl 2:S174-S179. doi:10.1542/peds.2013-1021R 

    Patrick SW, Burke JF, Biel TJ, Auger KA, Goyal NK, Cooper WO. Risk of Hospital Readmission Among Infants With Neonatal Abstinence Syndrome. Hosp Pediatr. 2015;5(10):513-519. doi:10.1542/hpeds.2015-0024 

    Van Horn A, Powell W, Wicker A, Mahairas AD, Creel LM, Bush ML. Outpatient healthcare access and utilization for neonatal abstinence syndrome children: A systematic review. J Clin Transl Sci. 2019;4(5):389-397. Published 2019 Aug 29. doi:10.1017/cts.2019.407 

    Stumbras, K., Rankin, K., Caskey, R. et al. Guidelines and Interventions Related to the Postpartum Visit for Low-Risk Postpartum Women in High and Upper Middle Income Countries. Matern Child Health J 20 (Suppl 1), 103–116 (2016). https://doi.org/10.1007/s10995-016-2053-6 

    Behnke M, Smith VC; Committee on Substance Abuse; Committee on Fetus and Newborn. Prenatal substance abuse: short- and long-term effects on the exposed fetus. Pediatrics. 2013;131(3):e1009-e1024. doi:10.1542/peds.2012-3931 

    Smith VC, Wilson CR; COMMITTEE ON SUBSTANCE USE AND PREVENTION. Families Affected by Parental Substance Use. Pediatrics. 2016;138(2):e20161575. doi:10.1542/peds.2016-1575 
    Fill MA, Miller AM, Wilkinson RH, et al. Educational Disabilities Among Children Born With Neonatal Abstinence Syndrome. Pediatrics. 2018;142(3):e20180562. doi:10.1542/peds.2018-0562 
    Lloyd, Margaret H. & Akin, Becci A. & Brook, Jody, 2017. "Parental drug use and permanency for young children in foster care: A competing risks analysis of reunification, guardianship, and adoption," Children and Youth Services Review, Elsevier, vol. 77(C), pages 177-187. 

    National Academies of Sciences, Engineering and Medicine. (2016). Parenting matters: Supporting parents of children ages 0–8. Washington, DC: The National Academies Press. 

    U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: Author. Retrieved from https://addiction.surgeongeneral.gov/supplementary-materials 

  • Team-member Publications and Presentations

    Peer-Reviewed Manuscripts 

    • Bailey, B.A., Chroust, A., Justice, N., & Wood, D. (in press). Utilization and accuracy of various methods to assess opioid use during pregnancy and at delivery: How well are we determining which newborns need to be monitored for the development of neonatal opioid withdrawal syndrome (NOWS)? Journal of Substance Use. 

    • Bailey, B. A., Shah, D. S., Boynewicz, K. L., Justice, N. A., & Wood, D. L. (2022). Impact of in utero opioid exposure on newborn outcomes: beyond neonatal opioid withdrawal syndrome. The Journal of Maternal-Fetal & Neonatal Medicine, 35(25), 9383-9390. 
    • Boggs, T., & Ferguson, N. (2016). A little PEP goes a long way in the treatment of pediatric feeding disorders. Perspectives of the ASHA Special Interest Groups, 1(13), 26-37.
    • Boynewicz, K., Campbell, S., & Chroust, A. (2023). Early identification of atypical motor performance of infants with prenatal opioid exposure. Physical Therapy & Rehabilitation Journal, 35(3), 359-365. DOI: 10.1097/PEP.0000000000001021

    • Gersch, H., Shah, D., Chroust, A., Wood, D., & Bailey, B. (2023). Can umbilical cord testing add to maternal urine drug screen for evaluation of infants at risk of neonatal opioid withdrawal syndrome? The Journal of Maternal-Fetal & Neonatal Medicine, 36(1) 221706. DOI: 10.1080/14767058.2023.2211706 


    • Shah, D., Turner, E., Chroust, A., Duvall, K., Wood, D., & Bailey, B. (2022). Marijuana use in opioid-exposed pregnancy increases risk of preterm birth. The Journal of Maternal-Fetal & Neonatal Medicine, 35(2), 8456-8461. https://doi.org/10.1080/14767058.2021.1980532 


    Invited Presentations 

    • Chroust, A. (July 14, 2022). Infant Motor and Cognitive Development. Higher Education Workgroup FF22. AIMHiTN, virtual. 

    • Chroust, A. (August 16, 2019). Risk Factors Associated with the Severity of Neonatal Abstinence Syndrome. A Tough Pill to Swallow- Addressing the Epidemic of Prescription Drug Abuse. Kingsport, TN. 
    • Johnson, M., Isbell, C., Boggs, T. (2023).  Nutrition & Feeding Considerations for Infants and Young Children with Prenatal substance exposure. University of Washington- Community Feeding Teams Meeting. May 23, 2023. (Oral presentation, invited).


     Presentations in Professional Meetings 


    • Agarawal, D. Shah, D., & Chroust, A. (2022). Postpartum Mental Health in Women with Opioid Use Disorder: Results of Preliminary Data. Southern Society for Pediatric Research. New Orleans, LA, February 10-12, 2022. 
    • Boynewicz, K., Chroust, A., & Campbell, S. (2022). Atypical Early Detection of Atypical Motor Performance of Infants at Risk Secondary to Neonatal Opiate Withdrawal Syndrome. American Physical Therapy Association’s Combined Sections Meeting. San Diego, CA. February 23-25, 2023. (Poster presentation, accepted). 
    • Boynewicz, K., Chroust, A., & Johnson, M. (2022). What do you know about prenatal drug exposure? Motor, cognitive, neurobehavior and the gut-brain connection. Academy of Pediatric Physical Therapy. Portland, OR, Nov 18-20, 2022. (Oral presentation, accepted).  
    • Boynewicz, K., Street, K., Binns, D., Bumett, C., Bankston, M., Patterson, S., & Chroust, A. (2022). Visual Stress Cues and Atypical Eye Movements During a Visual Task in Infants with Prenatal Opioid Exposure. Academy of Pediatric Physical Therapy. Portland, OR, Nov 18-20, 2022. (Poster presentation, accepted).  
    • Chroust, A., Boynewicz, K., Thomas, K., Wahlquist, A., Clark, W.A. (2023). Gut Microbiota in Infants Exposed to Opioids In Utero. Society for Research in Child Development. Salt Lake City, UT. March 23-25, 2023. (Poster presentation, accepted). 
    • Creasman, J. Chroust, A., Boynewicz, K., & Schetzina, K. (2022). Analyzing the Effects of Feeding Type and Prenatal Substance Exposure on Infant Weights. ETSU Annual Pediatric Conference. Johnson City, TN. August 6, 2022. *1st Place poster award
    • Jain, M., Shah, D., & Chroust, A. (2022). Does Integrated Management of Opioid Use Disorder Affect Outcomes of Neonatal Abstinence Syndrome Diagnosis: Results of Preliminary Data. Southern Society for Pediatric Research. New Orleans, LA, February 10-12, 2022.
    • Johnson, M., Chroust, A. Boynewicz, K., Bonner, C., Kromash, J., & (2022). Neonatal Opioid Withdrawal Syndrome and the Impact on Early Growth in Infants. Academy of Nutrition and Dietetics: Food & Nutrition Conference and Expo. Orlando, FL. October 8-11, 2022. (Poster presentation, accepted).
    • Johnson, M., Isbell, C., Boggs, T. (2022).  Prenatal drug exposure: Interprofessional approaches to improving pediatric feeding outcomes.  Academy of Nutrition and Dietetics: Food & Nutrition Conference and Expo. Orlando, FL. October 9, 2022.(Oral presentation, accepted).
    • Johnson, M., Pham, A., Duvall, K., Greenman, M., Price, R., Bishop, K., Bundy, K., Schetzina, K. (2023). Perinatal substance exposure: A retrospective chart review of outcomes in the rural primary care setting.  Academy of Nutrition and Dietetics: Food & Nutrition Conference and Expo. Denver, CO. October 7-10, 2023. (Poster presentation, accepted).
    • Johnson, M., Wahlquist, A., Thomas, K., Clark, A., Boynewicz, K., Chroust, A. (2023). Comparing maternal diet and fecal SCFA profiles of infants with and without prenatal opioid exposure. American Society of Nutrition Conference. Boston, MA. July 22-25, 2023.  (Poster presentation, accepted). 
    • Puhr, D., Pirozzi, E., Tuell, D., Schetizna, K. (2023). Three Years Experience Enhancing the Medical Home for Children with Prenatal Drug Exposure and Their Families with Baby Steps. American Academy of Pediatrics National Conference & Exhibition. Washington, DC. Oct 20-24. (Poster presentation, accepted)

 

ETSU Health Pediatrics
325 N. State of Franklin Rd.
Johnson City, TN 37604
423-439-7320

 

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