Babies exposed to cocaine before birth may not present all the medical, educational and social burdens once feared.
Researchers in Chicago have found that of about 300 babies born to women cocaine users, fewer than a half dozen children require special education-classes in school. The ongoing seven-year study is one of the world’s longest-running research projects on cocaine-exposed babies.
Cocaine babies, as they’re known, are not a “biologic underclass” that will challenge school systems beyond capacity, says Dr. Ira Chasnoff, director of the National Association for Perinatal Addiction Research and Education, an international, non-profit research and education organization in Chicago. Overall, he says, these children do well in school and in life “if other major risk factors in their lives are addressed and interventions to correct those factors are undertaken.” In fact, all school-age children in the study who have received therapy from Chasnoff’s organization have been enrolled for mainstream school curricula, he says.
Most mothers in the study had used one or more illicit drugs at least once per week before entering the drug treatment program designed for pregnant women; 40 percent became drug free and 60 percent significantly reduced amount of illicit drugs taken during pregnancy.
Studying the children of these mothers, Chasnoff concludes that the findings “get to the fundamental argument, nature versus nurture.” At birth, he says, biology counts heavily, “but by age 3, the importance of environment is equal and beginning to surpass the importance of biological exposure.” By addressing the stability of the home and helping cocaine-exposed children learn to focus attention, Chasnoff says, “you can actually raise the IQ of the child.”
He and other researchers have found that throughout early childhood, babies who had been prenatally exposed to illicit drugs tend to have lower intelligence test scores than peers who had not been exposed. But those that had early intervention to help them focus their attention and control their behavior consistently scored higher than drug-exposed children who did not receive these services.
As many as 75 percent of cocaine-exposed babies show behavior problems and about 25 percent suffer medical abnormalities, such as growth deficiencies, brain hemorrhages and respiratory difficulties, compared to babies whose mothers did not use cocaine during pregnancy, says Chasnoff, an associate professor of pediatrics at Northwestern University Medical School. By age 1, he says, most medical problems will have been dealt with, so developmental issues become the prime concern.
Typically, a cocaine-exposed baby has difficulty handling stimulation, Chasnoff says. So he teaches parents and care givers to introduce new things slowly and one at a time. For example, infants are swaddled tightly to limit the baby’s movements, babies are spoken to before they’re picked up, to help them adjust to the presence of another person, he says.
Pinpointing the source of developmental problems in cocaine-exposed babies is difficult, Chasnoff says. First, it’s often hard to discern whether the mother took only cocaine, or used other drugs as well, which is more likely, he says. The frequency of cocaine use, the amount and form (inhaled, smoked or injected) also may have a bearing, but no studies have explored it.
Also, it’s difficult to assess how many women take cocaine during pregnancy. A 1989 study, based on questionnaires and urine testing done at two different times at Boston City Hospital, found that 18 percent of the women giving birth there had used cocaine during pregnancy.
The Center for the Future of Children, a non-profit organization in Fairfax, Va., estimates that each year about 4.5 percent of all newborns, about 160,000, are exposed to cocaine before birth, and about 18 percent, or more than 600,000, are prenatally exposed to some type of illicit drug.
In a 1991 report estimating the number of drug-exposed infants, the center noted that many women are never questioned about drug use during pregnancy, and certainly some who have used cocaine deny doing so; routine urine sampling shows only recent drug use.
Allowing for all those variables, Chasnoff estimates that each year more than 500,000 children are exposed prenatally to cocaine and other illicit drugs, and about 300,000 of them suffer some damage from the exposure.
Some developmental problems show up at age 3 or 4, Chasnoff says. For example, a boy who was adopted immediately after birth showed no sign of harm from the alcohol and cocaine his mother was known to have used during pregnancy. When he turned 4, however, he had a flurry of uncontrollable outbursts, and would run screaming through the house, Chasnoff recounts.
The outbursts always seemed to happen when the boy’s two older brothers returned from school, so Chasnoff suggested that the mother engage the boy in an activity such as drawing about 10 minutes before the brothers came home. It didn’t work. At Chasnoff’s suggestion, the boy’s father cut a large circle of wood for the boy to sit on while he drew.
The brothers came home, “the kid ignored them. The circle gave him set limits,” Chasnoff explains. Although researchers can’t prove the preschooler’s behavior difficulties stemmed from prenatal drug exposure, such behaviors are more common in drug-exposed children.
Several states require doctors to report substance abuse during pregnancy. In 1990 Minnesota mandated prenatal testing for women whose physicians suspected illicit drug use.
Eight other states-Florida, Illinois, Indiana, Massachusetts, Minnesota, Nevada, Oklahoma and Utah-have similar laws that require doctors to report the mother once the child is born.
Mothers have been criminally prosecuted in 19 states, including Illinois, Indiana, Michigan and California, for using illicit drugs during pregnancy; however, none have been convicted.
Chasnoff says that state and federally supported prevention programs could help rehabilitate drug-using women, particularly during pregnancy.
“For every dollar we spend on prenatal care and drug treatment,” he says, “we save $10 to $15 in long-term care for drug-exposed children.”
