Copyright 1990 Newsweek
February 12, 1990 , UNITED STATES EDITION


LENGTH: 1407 words

HEADLINE: The Crack Children


Their troubles don't end in infancy. As cocaine babies grow up, health and social workers are discovering a whole new set of drug-related problems.

   Arthur was already 3 days old when his aunt found him in the Houston garage where his crack-addicted mother had abandoned him. Arthur's aunt adopted him, but at 13 months, he was so wild that his aunt called him "possessed. " She brought him to a special program for infants sponsored by Houston's Mental Health and Mental Retardation Authority. There, he would not let his teacher, Geynill Agee, come closer than eight feet before he began hurling toys at her. Two years later Agee thinks she has made a little progress with the boy; he can now walk calmly down the hall holding his aunt's hand -- something he could never do before.

Christina, another 3-year-old in the Houston program, does not like to be touched. Her teacher tried gently rubbing the child's skin with soft toys. Most made Christina shrink away. Finally, Christina became interested in puzzles, but rather than pick up the pieces herself, she would gingerly hold her teacher's wrist while the woman put the pieces together.

Arthur and Christina (not their real names) are among the oldest of a generation of children across the country who share a terrible heritage -- their mothers all smoked crack while they were pregnant. A few years ago crack-exposed babies made headlines when they began showing up in intensive-care nurseries. Then, the struggle was just to get them out of the hospital. Now, experts say, their problems appear to be long-term -- and far more difficult to solve.

The first wave of crack babies is just approaching school age, and educators are frustrated and bewildered by their behavior. "They operate only on an instinctual level, " says Agee of her students. "They eat and sleep, eat and sleep. Something has been left out. " Sometimes withdrawn, these children may have trouble playing or even talking with other kids. Some have tremors or periods when they seem to tune out the world. No one yet knows how to undo the damage caused by a pregnant woman's drug use. Some teachers predict that special-education programs like the one in Houston will soon be swamped with crack children. "We need experts to deal with them immediately, " says a spokesperson for the city's mental- health authority. "But who will be the experts? We are all having to learn about this one together. "

There's no question that the need is tremendous. According to a major national study of the problem, about 11 percent of all newborns -- 375,000 babies annually -- have been exposed to drugs in utero. Crack cocaine is the primary addiction of pregnant women, although many use other drugs as well. The doctor who conducted that 1988 study, Ira Chasnoff, president of the National Association for Perinatal Addiction Research and Education, thinks his results probably understate the problem because a mother's drug use can be hard to detect. Drug screening is not routine in many hospitals, and even with testing, crack use is not always obvious.

Without reliable testing, doctors must look for other clues. For example, pregnant crack addicts may not visit a doctor until they actually go into labor and are ready to deliver -- and sometimes not even then. "When a patient comes in with no history of prenatal care, we automatically start wondering if there's been drug abuse, " says Dr. Ezra Davidson of King-Drew Medical Center in Los Angeles. Davidson, who is also president of the American College of Obstetricians and Gynecologists, estimates that a quarter of the babies coming into his hospital's intensive-care nursery have drug-related problems.

Many of these babies start their lives with serious handicaps. They are likely to be born prematurely, says Dr. Gordon B. Avery of Children's National Medical Center in Washington, D.C., and may weigh as little as two pounds. "They get hit with everything other premature babies do -- plus, " Avery says. Compared with other preemies, they're more likely to have hydrocephaly (water on the brain), poor brain growth, kidney problems and apnea (when babies suddenly stop breathing). They are also more likely to have suffered an infarct of the brain -- similar to a stroke.

Birth defects: And that's only the beginning. Doctors who have followed the progress of crack babies now believe their drug-related birth defects may contribute to major developmental difficulties. Dr. Judy Howard of the UCLA School of Medicine, who has studied hundreds of crack children, says that they are hard to care for almost from the moment of birth. They may be either extremely irritable or very lethargic, have poor sucking abilities that hamper feeding and irregular sleep patterns. As they grow older, they may be hyperactive, slow in learning to talk and have trouble relating to other people -- just like Arthur and Christina, the youngsters in the Houston program.

As part of her research, Dr. Howard compared preemies born to crack users with other (noncrack) preemies. Even at the age of 18 months, after receiving good medical care and educational therapy, the crack kids were in bad shape. They tended to hit their toys or throw them around the room, without apparent motive or provocation. "Their facial expressions appeared flat and joyless and their body language did not demonstrate enthusiasm, " says Howard, who points out that children who can't or won't play with toys are missing an important avenue of development. "The kids have an impairment that makes them disorganized in everything they do, " she says. Doctors haven't been able to pinpoint the exact reason for these problems, but they suspect neurological damage. Howard says it's as if the part of the brain that "makes us human beings, capable of discussion or reflection, " has been "wiped out. "

Early intervention: So far, there are only a handful of programs dedicated to helping crack children. At the Salvin Special Education School in Los Angeles, teacher Carol Coles says her two-year-old program is still experimental; every day she and he colleagues try to figure out new ways to help the kids. Early intervention and individual attention seem to be crucial. There are no more than eight 3- and 4-year-olds in each class with as many as three teachers. Much of the day is taken up with regular preschool activities -- songs, games, art projects. But the school also has a pediatrician, psychologists, social workers and speech and language specialists. They're all ready to help with the problems caused not only by the mother's crack use, but also by the youngsters' often chaotic home lives. In some of their families, drug use is still a factor. That puts these kids at high risk for abuse and neglect. Doctors also suspect that the children may be seriously injured just by breathing the crack-filled smoke in their homes. Cole says that the continuity and routine at school help the kids feel secure. They also get lots of opportunities to talk about things that may be bothering them. "We acknowledge what exists, " says Cole. "We talk about the specifics of their lives. And they feel safe when they know we know. "

Lost generation: As America's crack problem worsens, health and social workes are left with only two options: get mothers into treatment programs in time to protect their babies, or prepare to deal with a steady stream of troubled children. Unfortunately, many drug facilities exclude pregnant women; in one recent study of programs in New York City, 54 percent wouldn't let these mothers in. And once children are born to crack mothers, the problems become even more daunting. "We simply can't take all these babies away from their mothers, " says Dr. Loretta Finnegan of Jefferson Medical College in Philadelphia, who has worked with pregnant addicts for many years. "Where are we going to put them? " In addition to stepping up -- and paying for -- drug enforcement and drug treatment, the country now must confront a whole new facet of the crack epidemic: an entire generation that may never be free of the scourge.
Damage Done
* At least 375,000 babies are born annually to mothers who use drugs.
* One survey estimates that the number of drug-exposed infants has more than tripled since 1985.
* Cocaine cuts the flow of nutrients and oxygen to the fetus, causing deformities and growth impairment.

* Drug-exposed 2-year- olds have trouble concentrating, interacting with groups and coping with structured environments.

GRAPHIC: Picture, Tragic start: Pregnant crack user, EUGENE RICHARDS -- MAGNUM, Photos 1 and 2, Doing what they can: Teachers with crack kids at the Salvin School, LESTER SLOAN -- NEWSWEEK


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