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Section 9
Act 54 of 2018: Mandatory Notification of Substance Exposed Infants by Health Care Providers & Plan of Safe Care

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A health care provider shall immediately give notice or cause notice to be given to DHS if the provider is involved in the delivery or care of a child under one year of age and the health care provider has determined, based on standards of professional practice, the child was born affected by: [48]
-substance use or withdrawal symptoms resulting from prenatal drug exposure; or
-a Fetal Alcohol Spectrum Disorder.

Notification to DHS can be made to ChildLine, electronically through the Child Welfare Portal or by calling 1-800-932-0313. This notification is for the purpose of assessing a child and the child's family for a Plan of Safe Care and shall not constitute a child abuse report. [48]

Health care provider – a licensed hospital or health care facility or person who is licensed, certified, or otherwise regulated to provide health care services under the laws of this Commonwealth, including a: [48]

  • physician
  • podiatrist
  • optometrist
  • psychologist
  • physical therapist
  • certified nurse practitioner
  • registered nurse
  • nurse midwife
  • physician’s assistant
  • chiropractor
  • dentist
  • pharmacist; or
  • an individual accredited or certified to provide behavioral health services

Plan of Safe Care

After notification of a child born affected by substance use or withdrawal symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder: [48]

  • A multidisciplinary team meeting must be held prior to the child's discharge from the health care facility.
  • The meeting will inform an assessment of the needs of the child and the child’s parents and immediate caregivers to determine the most appropriate lead agency for developing, implementing, and monitoring a Plan of Safe Care.
  • The child's parents and immediate caregivers must be engaged to identify the need for access to treatment for any substance use disorder or other physical or behavioral health condition that may impact the safety, early childhood development, and well-being of the child.
  • Depending upon the needs of the child and parent(s)/caregiver(s), ongoing involvement of the county agency may not be required.


Supplementary Definition:
Multidisciplinary Team – for the purpose of informing the Plan of Safe Care, may include: [48]

  • Public health agencies;
  • Maternal and child health agencies;
  • Home visitation programs;
  • Substance use disorder prevention and treatment providers;
  • Mental health providers;
  • Public and private children and youth agencies:
  • Early intervention and developmental services;
  • Courts;
  • Local education agencies
  • Managed care organizations and private insurers; and
  • Hospitals and medical providers.

Case Study 5

You are completing a home visit with a mother (Mary) for the third time. She has a two-month-old baby boy, a three-year-old daughter and recently separated from her partner. She has a history of previous drug abuse and depression. She presents as tired and yawning frequently.

You go into the bathroom to wash your hands and notice there are used syringes uncapped on the bathtub. Mary insists these belong to a friend who visited last night and she is going to dispose of them soon. You examine the baby and observe a small purple bruise on the baby's left thigh. Mary tells you she is not sure how he got the bruise but thinks the three-year-old may have hit the baby as she is jealous of him.

When you weigh the baby he has only gained 2 ounces in 2 weeks, but Mary says he is drinking 4 fluid ounces of formula, six feeds a day. The three-year-old comes into the room and asks for breakfast. Mary tells her to stop hassling her; she will get it in a minute. It is now 11:00 am. [49]

Thoughtful Considerations:

-What are the many indications of abuse in this situation?
-Does Act 54 covered in this section require anything different of you in this situation versus with older children?
Updated 2023

48. Rizvi MB, Conners GP, King KC, et al. “Pennsylvania Child Abuse Recognition and Reporting.“ In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK565852/

49. "Child abuse and neglect education module: Responsability, recognizing, and reporting" Queensland Department of Health. 2013. https://www.health.qld.gov.au/__data/assets/pdf_file/0024/150693/childabuse-module.pdf.

Peer-Reviewed Journal Article References:
Babcock Fenerci, R. L., & DePrince, A. P. (2018). Shame and alienation related to child maltreatment: Links to symptoms across generations. Psychological Trauma: Theory, Research, Practice, and Policy, 10(4), 419–426.

Meeker, E. C., O'Connor, B. C., Kelly, L. M., Hodgeman, D. D., Scheel-Jones, A. H., & Berbary, C. (2021). The impact of adverse childhood experiences on adolescent health risk indicators in a community sample. Psychological Trauma: Theory, Research, Practice, and Policy, 13(3), 302–312.

Sousa, C., Mason, W. A., Herrenkohl, T. I., Prince, D., Herrenkohl, R. C., & Russo, M. J. (2018). Direct and indirect effects of child abuse and environmental stress: A lifecourse perspective on adversity and depressive symptoms. American Journal of Orthopsychiatry, 88(2), 180–188.

Wagner, M. F., Milner, J. S., McCarthy, R. J., Crouch, J. L., McCanne, T. R., & Skowronski, J. J. (2015). Facial emotion recognition accuracy and child physical abuse: An experiment and a meta-analysis. Psychology of Violence, 5(2), 154–162.

QUESTION 9
In what situations must a health care provider immediately give notice or cause notice to be given to DHS for a child under one year of age where the provider is involved in the delivery or child's care? To select and enter your answer go to Test.

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