Though no one has been able to link dosage to damage, common sense suggests that more cocaine is probably worse than less. Perhaps most important is the fact that by virtue of being in the program, they were getting prenatal care — a rarity for the vast majority of addicts.
A number have found staggering miscarriage and stillbirth rates — depending on which study you read, children of cocaine-abusing women stand as much as a sixty-percent chance of dying in utero or during the first year of life.
In some cities, crack is the abortion method of choice for regular users in the first trimester. For women about to give birth, street wisdom has it that a first-class binge will get labor going.
Maternity wards in major city hospitals are by now used to blitzed-out women having one-hour labors. Perhaps the most chilling studies have come from Dr. Suzanne Dixon, a behavioral and neuro-developmental pediatrician at University of California, San Diego. Dixon looked at a group of crack babies who had abnormal ECHO neurological ultrasound results — of that group forty-one percent had serious intercranial lesions.
In other words, they had holes in their brains. T he little boy sneaks over to a toy box and quickly stuffs two tiny plastic dolls in his pockets.
His sister, who has been scribbling up and down her arms with a ballpoint pen, looks up. She rams him hard, knocking him down, and begins clawing at his pockets. Matt has recently developed an attachment to these dolls. Even Serena seems to sense how important this is. And it drives her crazy. Matt now leans against his mother, fingering one of the Ninja dolls. Later, when her mother is distracted for a moment, Serena will slip away.
In less than a minute, the two-year-old will start a fire in the kitchen. Normal babies crave contact with other human beings. They love to be looked at, sung to and held. An instruction video for parents of crack babies shows a solemn doctor holding a wary baby facing outward.
Eye contact? Add light, maintain distance and hold the vocals. They cry in a high feline wail, sometimes for hours on end, and nothing can console them. That creepy catlike cry is itself indicative of neurological damage. And during a crying jag, their rigid little arms flap about, which makes them even more frantic: They seem to believe their arms belong to someone else, a vicious someone who relentlessly flogs them.
In short, these babies lack just about everything that makes adults coo. Crack leaves nothing to chance. Not only does it make babies only a mother could love, it wipes out that love as well. When pregnant crack addicts are asked to draw a self-portrait, they never draw themselves pregnant. They turn away from ultrasound pictures with revulsion. Drug counselors now look back to the days of heroin families with something verging on nostalgia. Heroin mothers could still buy groceries, they still occasionally gave a kid a bath.
Boarder babies are what you end up with when a man, a woman and crack get together. S erena lifts her shirt and points at her bellybutton. Serena tires of contemplating her navel. She runs to the cleaning closet, pulls out a broom and starts swinging. Lamps and books fly. Serena needs to be in a class of one. Charlie Kelley Knight, superintendent of public schools there.
About three years ago, Knight called a meeting with some of her kindergarten teachers. She was worried by the fact that so many kids were showing up completely unprepared for first grade.
The answer, she had decided, was to make kindergarten a more academic experience. Knight was prepared for some opposition from the teachers. She was not, however, prepared for mutiny. They have no friends. Since that time, Knight has developed a program for drug-exposed infants and toddlers in the community. She is justifiably proud of her results there. But her pride evaporates when the talk turns to the older drug-exposed children.
A lot of them have already been kicked out of school — these children are violent. These are the kids who one fine day bring guns to school. Social workers and teachers tend to get angry with Charlie Knight. They hate the way she uses the expression drug baby. They get worse. J udy Howard is thinking about giving up the lecture circuit. The UCLA pediatric researcher is tired of being attacked for her radically pessimistic views on the long-term prognosis for crack babies.
The violence abated somewhat, and the parents decided he was cured. Howard has repeatedly pleaded with her adoptive parents to go on TV to help spread the word. None will do it. Especially if you structure their environment, if you organize every aspect of it for them. You can sit on these children to get them to play blocks, you can even work at getting them to smile. Those are the successes that the early intervention people are talking about.
Organizational ability is a dreary way to describe what makes us read the paper over breakfast, select a birthday gift, sing in the shower or hurl our arms around a long-absent friend, but this is child-development-speak. A more evocative demonstration of the importance of organizational ability can be found in videotapes Howard has made of three different eighteen-month-olds at play.
The experiment compares crack children with controls from two groups of children crack babies are often likened to — children with unstable, sometimes abusive home environments and premature babies.
Each child was put in a room with a large variety of toys and left to play. In one sequence, the preemie heads straight for the dolls and enacts a bedtime scene in which he tucks the dolls into bed and kisses them good night. The child with an erratic home life is more interested in toy-sized eating utensils; she soon sets up a full-fledged tea party.
The cocaine child goes to the pile of toys and pulls out a spoon. Then he hurls it down. Same with a doll, a block, a truck, a ball. He seems engaged in a game of hot potato. At every step of the way, an observer has a good idea of what the preemie and the child with the unstable background will do next.
With the crack baby, there are no logical underpinnings to his play. Simply getting up each morning involves telling ourselves a story of what we hope the day will bring. Annie is a religious woman; she believes in the power of redemption, and she believed in the power of medicine.
Adopting Serena was a way of proving her faith that one day Matt would be well. A year later, Annie was learning sign language. And data does show that children can die, or experience profound physical difficulties, as a result of being exposed to drugs in the womb.
A study in Tennessee found that drug-exposed infants are more likely to develop learning disabilities and stay in the hospital much longer, an average of Other studies show that drug-exposed babies cost hundreds of thousands of dollars to keep alive as newborns and even more money in health expenses later in life.
And a report by the National Institute on Drug Abuse found those earlier forecasts were wildly overblown. Palmer is an example of how good medical treatment — and even better parenting — can help turn a tough start into a great life. The number of drug-exposed infants born in California nearly tripled over the decade between and , from 1, to 5, In Orange County, where Nancy lives, the number jumped from 84 in to in Nancy knows little about her birth mother; even less about her birth father.
Jim Palmer tried to help the birth mother regain custody, when Nancy was little, but the woman just stopped coming to court. So the Palmers nurtured the baby, who suffered as many as 15 seizures a day even as a toddler. The seizures damaged her nerve endings, says Nancy. As a toddler, she would walk into walls and not feel a thing. His family previously had fostered two boys and later fostered another girl.
All were ultimately adopted. But, aside from dyslexia and an allergy to tobacco, Nancy Palmer says she turned out pretty much normal. They have adopted three of their one-time foster children, rounding out a family that also includes two biological children, a year-old son and year-old daughter. In , the couple attended a workshop led by experts at the Orange County Department of Social Services. But after a time "we began to ask, 'Was there something else going on?
While the cocaine-exposed children and a group of nonexposed controls performed about the same on tests, both groups lagged on developmental and intellectual measures compared to the norm. Hurt and her team began to think the "something else" was poverty. As the children grew, the researchers did many evaluations to tease out environmental factors that could be affecting their development.
On the upside, they found that children being raised in a nurturing home - measured by such factors as caregiver warmth and affection and language stimulation - were doing better than kids in a less nurturing home. On the downside, they found that 81 percent of the children had seen someone arrested; 74 percent had heard gunshots; 35 percent had seen someone get shot; and 19 percent had seen a dead body outside - and the kids were only 7 years old at the time.
Those children who reported a high exposure to violence were likelier to show signs of depression and anxiety and to have lower self-esteem. More recently, the team did MRI scans on the participants' brains. Some research has suggested that gestational cocaine exposure can affect brain development, especially the dopamine system, which in turn can harm cognitive function. An area of concern is "executive functioning," a set of skills involved in planning, problem-solving, and working memory.
The investigators found one brain area linked to attention skills that differed between exposed and nonexposed children, but they could not find any clinically significant effect on behavioral tests of attention skills.
Drug use did not differ between the exposed and nonexposed participants as young adults. About 42 percent used marijuana and three tested positive for cocaine one time each. The team has kept tabs on of the children originally in the study.
Of the , two are dead - one shot in a bar and another in a drive-by shooting - three are in prison, six graduated from college, and six more are on track to graduate. There have been 60 children born to the participants. Other researchers also couldn't find any devastating effects from cocaine exposure in the womb.
Claire Coles, a psychiatry professor at Emory University, has been tracking a group of low-income Atlanta children. Her work has found that cocaine exposure does not seem to affect children's overall cognition and school performance, but some evidence suggests that these children are less able to regulate their reactions to stressful stimuli, which could affect learning and emotional health.
Coles said her research had found nothing to back up predictions that cocaine-exposed babies were doomed for life. Deborah A. Frank, a pediatrics professor at Boston University who has tracked a similar group of children, said the "crack baby" label led to erroneous stereotyping. They have to deal with so much stress and deprivation. We have also found that exposure to violence is a huge factor.
Frank said that cocaine - along with other illicit drugs, alcohol, and cigarettes - "isn't good for babies," but the belief that they would "grow up to be addicts and criminals is not true.
Some kids have stunned us with how well they've done. Jaimee Drakewood came to her last visit at Children's with her month-old son KyMani in tow. It was the 31st time she had met with the researchers. The team plans to stay in touch with study participants each year.
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