Innocent Victims

By Anastasia Toufexis

AT A HOSPITAL IN BOSTON lies a baby girl who was born before her time -- three months early, weighing less than 3 lbs. Her tiny body is entangled in a maze of wires and tubes that monitor her vital signs and bring her food and medicine. Every so often she shakes uncontrollably for a few moments -- a legacy of the nerve-system damage that occurred when she suffered a shortfall of blood and oxygen just before birth. Between these seizures, she is unusually quiet and lethargic, lying on her side with one arm draped across her chest and the other bent to touch her face, sleeping day and night in the comfort of her cushioned warming table. At best, it will be three or four months before she is well enough to leave the hospital, and even then she may continue to shake from time to time.

AT A THERAPY CENTER IN NEW YORK CITY, the saddest child brought in one morning is three-year-old Felicia, a small bundle of bones in a pink dress, whose plastic hearing aids keep falling off, tangling with her gold earrings. She is ( deaf, and doctors are not sure how much she can see. She functions at the capacity of a four-month-old. Like a rag doll, she can neither sit nor stand by herself: her trunk is too weak and her legs are too stiff. A therapist massages and bends the little girl's legs, trying to make her relax. Next year her foster mother will put Felicia in a special school full time in hopes that the child can at least learn how to feed herself.

AT A SPECIAL KINDERGARTEN CLASS IN THE LOS ANGELES AREA, a five-year-old named Billie seems the picture of perfect health and disposition. As a tape recorder plays soothing music in the background, he and the teacher read alphabet cards. Suddenly Billie's face clouds over. For no apparent reason, he throws the cards down on the floor and shuts off the tape recorder. He sits in the chair, stony faced. "Was the music going too fast?" the teacher asks. Billie starts to say something, but then looks away, frowning. The teacher tries to get the lesson back on track, but Billie is quickly distracted by another child's antics. Within seconds, he is off his chair and running around.

These children have very different problems and prospects, but they all have one thing in common: their mothers repeatedly took crack cocaine, often in combination with other drugs, during pregnancy. That makes them part of a tragic generation of American youngsters -- a generation unfairly branded by some as "children of the damned" or a "biologic underclass." More often, they are simply called crack kids. A few have severe physical deformities from which they will never recover. In others the damage can be more subtle, showing up as behavioral aberrations that may sabotage their schooling and social development. Many of these children look and act like other kids, but their early exposure to cocaine makes them less able to overcome negative influences like a disruptive family life.

The first large group of these children was born in the mid-1980s, when hundreds of thousands of women began to get hooked on the cheap, smokable form of cocaine known as crack. The youngsters have run up huge bills for medical treatment and other care. Now the oldest are reaching school age, and they are sure to put enormous strain on an educational system that is already overburdened and underachieving.

Their plight inspires both pity and fear. Pity that they are the innocent victims of society's ills. Pity that the odds will be stacked against them at , home, on the playground and in school. Fear that they will grow into an unmanageable multitude of disturbed and disruptive youth. Fear that they will be a lost generation.

The dimensions of the tragedy are staggering. According to the National Association for Perinatal Addiction Research and Education (NAPARE), about 1 out of every 10 newborns in the U.S. -- 375,000 a year -- is exposed in the womb to one or more illicit drugs. The most frequent ingredient in the mix is cocaine. In major cities such as New York, Los Angeles, Detroit and Washington many hospitals report that the percentage of newborns showing the effects of drugs is 20% or even higher.

The cost of dealing with these children is rapidly escalating. In California drug-exposed babies, many of whom are born prematurely, stay in the hospital almost five times as long as normal newborns (nine days, vs. two days) and their care is 13 times as expensive ($6,900, vs. $522). And that is only the beginning, since many of the crack kids are placed in foster care. In New York City annual placements of drug-affected babies run to 3,500, compared with 750 before the spread of crack. That brings the city's foster-care tab to about $795 million (up from $320 million in 1985). The New York State comptroller's office expects that New York City will spend $765 million over the next 10 years on special education for crack kids.

Among the most visible victims are black and other minority children born into crack-plagued ghettos. It is bad enough that the drug assaults children in the womb, but the injury is too often compounded after birth by an environment of neglect, poverty and violence. "I sometimes believe that babies are better protected before they are born than they are after," says Dr. Barry Zuckerman, head of the division of developmental and behavioral pediatrics at Boston City Hospital.

Even after they give birth to drug-impaired children, many mothers go right on smoking crack. Melinda East, a former crack addict now in treatment in Long Beach, Calif., supported her habit as an often barefoot street prostitute. Her first baby was born with "the shakes," she says, but that did not turn her away from crack. She remembers selling milk and Pampers back to the grocery store for drug money.

Local governments often take crack kids away from still addicted mothers, but that does not guarantee stability for troubled children. Charlie, a five- year-old Los Angeles-area boy with severe behavioral problems, went through three foster homes before an elderly couple became his guardians. He seems to be making progress, but his prospects appear limited. He sometimes erupts into frenzied episodes of thrashing about, pulling his hair, biting and banging his head against a wall.

While poor, black ghetto children have attracted the most attention, they are far from being the only members of the crack generation. Cocaine abuse is common among members of the white upper and middle classes, but it is hidden better. Their babies are usually born at private hospitals that rarely ask mothers about drug use or screen them and their children for illegal chemicals. A 1989 Florida study found similar rates of drug use among pregnant white and black women of equal socioeconomic status, but only 1% of white abusers were reported to authorities, compared with nearly 11% of blacks.

Billie, the kindergartner, is a white child whose mother was addicted to crack, among other drugs. Soon after birth, Billie was whisked away from her and given to wealthy adoptive parents. Growing up in a stable environment, however, has not prevented him from being kicked out of four preschools for disorganized, rowdy behavior. Only when he started at this new school, where his teachers are trained to handle drug-exposed children, did he begin to calm down.

The crack kids are not the first children to be devastated by drugs while their mothers were pregnant. For many years, the unborn have been exposed to opiates, barbiturates, inhaled cocaine and a panoply of other drugs. And fetal alcohol syndrome, brought on by drinking during pregnancy, is believed to be a leading cause of mental retardation in the young.

But the coming of crack made a bad situation worse. This readily available, easily ingested chemical has lured far more women into addiction than any other hard drug has. By the latest estimates, more than 1 million U.S. women use cocaine. Moreover, crack has spurred the use of other drugs. Women who take cocaine are likely to use heroin to prolong a high, then tranquilizers and alcohol to come down. They may indulge in marijuana, PCP and amphetamines. As a result, many crack babies steep in a stew of drugs while in the womb.

AN UNCERTAIN FUTURE

How badly are they damaged? In most cases, no one knows for sure. The question has sparked a fierce debate among doctors, social workers, educators and law- enforcement specialists. On one side are those who fear that most of the * children are irredeemably harmed; on the other are those who firmly believe that with enough early treatment for babies and their mothers and special education, the large majority of crack kids can lead normal lives.

Among those who think the damage may be permanent is Kathy Kutschka, a director at the Speech and Language Development Center in Buena Park, Calif. Her department works with 45 crack kids, up to kindergarten age. When she observes them having trouble sitting in a chair or picking up a pencil, she despairs for their future. "Of the children we see," says Kutschka, "none will be able to function in a normal life-style without some kind of sheltered living arrangement."

An increasing number of medical experts, however, vehemently challenge the notion that most crack kids are doomed. In fact, they detest the term crack kids, charging that it unfairly brands the children and puts them all into a single dismal category. From this point of view, crack has become a convenient explanation for problems that are mainly caused by a bad environment. When a kindergartner from a broken home in an impoverished neighborhood misbehaves or seems slow, teachers may wrongly assume that crack is the chief reason, when other factors, like poor nutrition, are far more important.

Even when crack is responsible, the situation is rarely hopeless. "This is not a lost generation," says pediatrician Evelyn Davis of Harlem Hospital in New York City. "These children are not monsters. They are salvageable, capable of loving, of making good attachments. Yes, they present problems that we have not dealt with before, but they can be taught."

THE COST OF COMPASSION

Help is possible if society will pay the price -- a very big "if" in these days of tight budgets. Will taxpayers foot the bill to provide the best treatment and schooling to all the crack kids? In Boston a year of special education for a drug-exposed child can cost $13,000, compared with $5,000 spent per youngster at a regular school.

Experts agree that the most vital first step in helping crack kids is to get their mothers off the drug, preferably before birth. Yet only 11% of pregnant addicts get into treatment. Many detox programs do not accept the women because they are not equipped to deal with prenatal medical needs. And very few programs are designed to help drug-dependent women who already have children.

The failure to spend more money for early rehabilitation of crack addicts , and their babies may be a social and financial disaster in the long run. Contends T. Berry Brazelton, the noted Harvard pediatrician: "If we worked with these infants from the first, it would cost us one-tenth or one-hundredth as much as it will cost us later. To educate them, to keep them off the streets, to keep them in prisons will cost us billions."

WHAT THE DRUG DOES

Cocaine causes blood vessels to constrict, thus reducing the vital flow of oxygen and other nutrients. Because fetal cells multiply swiftly in the first months, an embryo deprived of a proper blood supply by a mother's early and continuous use of cocaine is "dealt a small deck," says Zuckerman of Boston City Hospital.

Such babies look quite normal but are undersized, and the circumference of their heads tends to be unusually small, a trait associated with lower IQ scores. "Only the most intensive care after birth will give these babies a chance, but many won't receive it," Zuckerman points out.

Occasionally, heavy maternal cocaine use during the later months of pregnancy can lead to an embolism, or clot, that lodges in a fetal vessel and completely disrupts the blood supply to an organ or limb. The result: a shriveled arm or leg, a missing section of intestine or kidney, or other deformities. Such glaring defects, however, are extremely rare.

Cocaine exposure affects brain chemistry as well. The drug alters the action of neurotransmitters, the messengers that travel between nerve cells and help control a person's mood and responsiveness. Such changes may help explain the behavioral aberrations, including impulsiveness and moodiness, seen in some cocaine-exposed children as they mature.

Ultrasound studies of 82 drug-exposed infants by researchers at the University of California at San Diego revealed that about a third have lesions in the brain, usually in the deeper areas that govern learning and thinking. While a similar percentage of babies who are ill but have not been exposed to drugs have such lesions, only 5% of healthy newborns do. The long-term significance of this finding is uncertain, since the brain continues to develop during a baby's first year. If there is damage, it may not surface until a child takes on such complex tasks as learning to talk.

At birth, cocaine babies generally perform poorly on tests measuring their responsiveness. And at one month, some of the infants still do not perform at the level of normal two-day-olds. Cocaine-exposed babies are easily overstimulated. When that happens, some turn fussy for a while and then doze off; others tense up and squall for hours.

Caring for such infants is frustrating. "You don't do things that come naturally," notes Diane Carleson, a foster mother in San Mateo, Calif. "The more you bounce them and coo at them, the more they arch their backs to get away. Their poor mothers want so badly to make contact, yet they are headed for rejection unless they learn how not to overstimulate them."

Doctors at Harlem Hospital studied 70 such toddlers just under age 2 and found that almost all were slow in learning to talk and that more than half had impaired motor and social skills. An inability to distinguish between mothers and strangers is another hallmark of crack-exposed youngsters.

As the children reach school age, it becomes more difficult to separate the impact of drugs from the effects of upbringing and other influences. Yet many teachers think they can see the lingering legacy of crack. Beverly Beauzethier, a New York City kindergarten teacher, agonizes over some of her pupils. "They have trouble retaining basic things. They are not sure of colors or shapes or their names." Their behavior is also out of the ordinary. "Some are passive and cry a lot; sometimes they just sit in a heap in the corner," says Beauzethier. Even worse, "they can be very aggressive with the other children so that they are hard to stop, and I have to hold their arms," she says. "This is very scary. We don't know a lot about handling these children."

HELPING HANDS

Doctors and educators are only beginning to design the programs needed to help the crack kids. One notable pilot project is Zuckerman's Women and Infants Clinic at Boston City Hospital, which uses what Zuckerman calls the "one-stop shopping" technique. While pediatricians and child-development experts work with babies, addicted mothers get help in kicking their habits and learn how to care for their children. The first eight babies in the program, tested at age 1, all fell within the normal range on the Bayley scale of infant development; this means they can play pat-a-cake, walk unassisted, jabber expressively and turn pages in a book.

One of the leading organizations working to help older children is the Salvin Special Education Center in Los Angeles, which conducted a three-year pilot program with 50 drug-exposed kids, ages 3 to 5. Salvin's educators cite % several elements of a successful school program: small classes (eight pupils to one teacher), fixed seat assignments and a rigid routine, and protection from loud noises and other disturbing stimulation. Activities are emphasized over paper-and-pencil exercises. "We'll read a story and bring it to life with hand puppets," explains school psychologist Valerie Wallace. Generous warmth and praise help youngsters achieve an emotional equilibrium. Of all Salvin's drug-exposed children, more than half have been able to transfer to regular school classes, with special tutoring and counseling.

Whether such success can be replicated on a large scale is uncertain, but the evidence is encouraging. A study by Dr. Ira Chasnoff and his staff at Chicago-based NAPARE followed 300 cocaine-exposed babies who, along with their mothers, received intensive postnatal intervention. Of 90 children tested at age 3, 90% showed normal intelligence, 70% had no behavioral problems, and 60% did not need speech therapy.

That may be less than complete success, but considering the horrible blow these children suffered before birth, it is remarkable that so many can be helped so much. The studies suggest that early intervention can give the children a fighting chance of leading reasonably normal lives. Such a payback seems more than enough to justify a far greater investment in treatment and rehabilitation. Today's crack kids may be a troubled generation, but they do not have to be a lost generation -- unless society abandons them.

With reporting by Mary Cronin/New York, Melissa Ludtke/Boston and James Willwerth/Los Angeles