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This study examines the parent\u2010child interaction quality and home environments of 92 New Zealand children with prenatal opioid exposure (OE) and 106 non\u2010opioid\u2010exposed (NE) children. Experiences for those in maternal care versus OOHC were of particular interest. Biological mothers completed a lifestyle interview during late pregnancy\/at birth. At 18 months, parent\u2010child interaction observations, maternal\/primary caregiver interviews, and the Home Observation for Measurement of the Environment were completed during a home visit. At age 4.5, children underwent developmental assessment. By 18 months, 20% of OE children were in OOHC. Mothers with OUD who were younger, less cooperative, and had increased polysubstance use during pregnancy were more likely to have lost custody of their child. OE children in their mother's care experienced less positive parenting and lower\u2010quality home environments than NE children. OE children in OOHC had similarly resourced environments to NE children, yet experienced lower levels of parental warmth and responsiveness. Early parenting predicted child cognition, language, and behavior 3 years later, underscoring the critical importance of supporting the parenting and psychosocial needs of OE children's parents\/caregivers to improve long\u2010term outcomes.<\/jats:p>","DOI":"10.1002\/imhj.22157","type":"journal-article","created":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T06:25:10Z","timestamp":1737095110000},"page":"343-358","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Early parent\u2010child interaction and home environments of children exposed prenatally to opioids: A comparison of biological mothers and out\u2010of\u2010home caregivers"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0444-6283","authenticated-orcid":false,"given":"Samantha J.","family":"Lee","sequence":"first","affiliation":[{"name":"Canterbury Child Development Research Group University of Canterbury  Christchurch New Zealand"},{"name":"Faculty of Health University of Canterbury  Christchurch New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Davie\u2010Gray","sequence":"additional","affiliation":[{"name":"Canterbury Child Development Research Group University of Canterbury  Christchurch New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianne J.","family":"Woodward","sequence":"additional","affiliation":[{"name":"Canterbury Child Development Research Group University of Canterbury  Christchurch New Zealand"},{"name":"Faculty of Health University of Canterbury  Christchurch New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,16]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000172"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.3109\/10826088309039348"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1207\/s15374424jccp2304_1"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.childyouth.2019.03.040"},{"key":"e_1_2_9_6_1","unstructured":"Caldwell B. 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