Drug Abuse

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drug abuse

When pregnant women abuse drugs, there is a much greater probability the infant will suffer birth defects. Drugs such as cocaine, "crack," heroin and other drugs, including prescription drugs that are not normally dangerous, can be highly perilous for the developing fetus and can cause lifelong problems to the child after birth.

Alcohol abuse is also a problem to the fetus, and children born to alcoholic mothers may suffer FETAL ALCOHOL SYNDROME and other effects.

Cocaine and Crack Babies

So-called crack babies are infants born to mothers addicted to cocaine and/or crack cocaine. (Crack cocaine is an inexpensive street form of cocaine, almost instantly addictive.) Estimates of the percentage of pregnant women using cocaine have ranged from 10% to as high as 28% in some areas. In a study of the sickest infants in an urban emergency department in New Haven, Connecticut, researchers found that over one-third of the children had been exposed to cocaine.

Studies have revealed that infants exposed to cocaine remain in the hospital longer after birth and receive more services than infants who were not exposed. A study reported in a 1997 issue of Pediatrics studied cocaine-exposed children in Shands Hospital in Jacksonville, Florida. The researchers found that the median hospital stay for the cocaine-exposed newborns was three days versus two days for the non-exposed babies. They also found hospital expenses were much higher for the cocaine-exposed infants: $7,054 was the mean hospital stay cost vs. $3,058 for non-exposed infants.

There is some good news, despite the distressing information on newborns exposed to cocaine. Earlier speculation about severe damage to children born addicted to cocaine appears to have been greatly overrated and the damage is far less than what was expected-certainly much less profound than the damage found in children with FETAL ALCOHOL SYNDROME. According to studies reported on in a 1998 issue of the Harvard Health Letter, children who are born with cocaine exposure may be smaller than average but the majority are in the average range. Many are also in normal health; for example, a study of 1,300 infants born to women who used cocaine during pregnancy revealed no increase in birth defects. Most of the children were also of normal intelligence.

The cocaine-exposed infants are often irritable for at least several weeks after birth and they experience disturbed sleep. As they grow, these children may also be hyperactive and have a low frustration tolerance as well as being easily aroused or startled. Researchers have found, however, that far more important than cocaine exposure during pregnancy is the mother's continued use of cocaine after the child is born, which is very detrimental. Also, as with alcohol addiction, women who are cocaine users often smoke and use other unhealthy or illegal substances that impair the child's environment, both prenatally and postnatally.

Contrary to popular perception, the problem is not seen only among poor people. Dr. Ira Chasnoff, an associate professor of pediatrics and psychiatry at Northwestern University, president of NAPARE and a noted researcher on the problem of drug babies, studied the rate of drug use among pregnant women in Florida and found almost no difference in the prenatal drug problem of poor women at public health departments and the problem among middle-class and upper-class women paying for private medical care. Nor did he find significant statistical differences when comparing drug abuse among pregnant women of different races, although black women are about 10 times more likely to be charged with drug abuse. Hospitals are seeing drug abusers of all socioeconomic statuses abandoning their infants, uncommon from all statuses in previous years.

Some common symptoms of cocaine babies are hyperactivity, poor feeding, rapid heart rate, excessive sudden movements and poor sleep patterns. Other typical traits are a low birth weight, low Apgar score and smaller than normal head circumference.

In addition, studies have revealed that cocaine can be transmitted to infants by breast-feeding mothers who have ingested cocaine up to 60 hours before breast-feeding the infant.

A study by the Centers for Disease Control in Atlanta found that woman who abuse cocaine in the early stages of pregnancy are also almost five times more likely to bear children with urinary tract defects. Other studies have revealed that cocaine abuse can lead to spontaneous abortion or stillborn infants.

Some indications of cocaine abuse in a pregnant women include early contractions, a hyperactive or inactive fetus, premature labor and "abruptio placenta," a premature separation of the placenta from the uterus that endangers the fetus.

In addition, many of these MEDICALLY FRAGILE infants may also suffer from aids because their mothers were sexually promiscuous and/or took the cocaine by using a contaminated needle. Many agencies routinely test newborn infants for both the HIV virus and drug presence.

Infants born with cocaine in their systems should also be tested for hepatitis, since this disease is passed through needle use by drug abusers and may be transmitted prenatally.

The extent of the cocaine abuse and when it was used during the pregnancy are also factors in the severity of the symptoms and problems evinced by a newborn infant. Physician Ira Chasnoff and his colleagues investigated the impact of cocaine abuse during only the first trimester of pregnancy compared to abuse throughout pregnancy.

According to the researchers, the continuous abusers had a higher rate of premature and low birthweight babies than those women who abused in the first trimester only; however, "both groups of cocaine-exposed infants demonstrated significant impairment of orientation, motor, and state regulation behaviors on the Neonatal Behavioral Assessment Scale."

Adoptive and biological parents need to understand that cocaine babies may have particular difficulty in responding to a parent. According to the authors of "The Care of Infants Menaced by Cocaine Abuse" in Maternal Child Nursing, "many are difficult to engage visually and exhibit jerky eye movements when they attempt to track. They may continue to be irritable and difficult to handle and may have limited interaction with people and objects in their environment."

If parents understand responses may be delayed, they are more likely to avoid the loop of frustration, trying less, increased frustration, and so on. For example, the cocaine baby may appear to dislike being picked up, so the parent will pick the child up less. Parents who realize less responsiveness is normal for a cocaine baby can more patiently continue to care for the child with love and affection.

It is impossible to quantify the personal pain of the children themselves and fearsome to speculate how they will behave as adults. One child was terrified of fires. His cocaine-addicted mother had frequently left him alone in abandoned buildings, and on one occasion, he was inside a burning building and could have easily died if someone had not saved him.

Even if children are not physically threatened by abuse or abandonment, many of the children are neglected and must learn to fend for themselves at an early age. Passersby have discovered toddlers attempting to cross busy highways, the situation unknown to their mother who is on a "high" and oblivious to reality.

Some cocaine babies have been placed in shelters, modern-day ORPHANAGES, whose caretakers attempt to deal with the children's basic needs. Children as old as one year may continue to live in the hospital because of overcrowded shelters.

Psychiatric experts have wondered out loud what ultimate effect this environment may have had on children.

One concern is a possible "failure to thrive," first documented in war orphans who were fed, bathed and cared for but did not receive the personalized affection of a parent or other caregiver. Another concern is whether such children will be able to meet developmental milestones they might have met if raised by a family.

Abusive or Neglectful Parents

If the parents abuse or neglect their children, the state will remove the children from the home and place them in foster care (See ABUSE.) If the mother is able to recover from her cocaine addiction, she may be able to parent her child effectively; however, there is also a high recidivism rate of cocaine abuse among mothers who bear children born with cocaine in their systems. At Northwestern University, 56% of the mothers studied are back on the drug within a month of the child's birth. Apparently there is also an association between when (and if) a mother requests help for her addiction-the later in her pregnancy a woman obtains formal treatment, the higher the probability she will use drugs again.

It's also not clear how much the prenatal environment and how much the postnatal environment affect learning and behavioral problems of children who were cocaine babies.

Children remaining in their biological homes with drug-abusing parents generally have very unfavorable environments, and some aspect of learning difficulties could theoretically be attributed to environment, while some aspects could be a result of actual neurological damage.

It would be enlightening to review a longitudinal study that compared and contrasted cocaine babies who are adopted as well as cocaine babies who remain in their biological homes.

Advice to Adoptive and Biological Parents of Cocaine Babies

Judith Schaffer of the New York State Citizen's Coalition for Children recommends parents try to avoid overexciting the cocaine baby. "Don't allow the infant to become frantic," she says. Indications of overexcitement include color changes, eye aversions, sneezes and other clues.

She also strongly recommends the use of swaddling blankets and pacifiers and gentle rocking. "Up and down rocking, as opposed to the more usual side to side, appears to be more comforting," Schaffer says.

Stimulation should be gentle, and babies should be played with when the baby appears ready to respond. The infants are far more stiff than a healthy baby and may need to be propped on their sides.

Schaffer recommends that the child be discouraged from standing until he or she can stand alone. She also actively discourages the use of jumpers or walkers for cocaine babies.

Some studies indicate that cocaine-exposed infants respond well to massage. In one study in which the babies were massaged for 30 minutes a day for 10 days, the infants showed less irritability than cocaine-exposed infants who were not massaged. They also gained more weight and showed other areas of improvement compared to the non-massaged infants.

Finding Foster and Adoptive Homes

It is becoming increasingly difficult to identify enough foster homes or adoptive homes for cocaine babies because they are very hard to care for. Social workers are struggling to deal with cocaine babies returned by foster parents who cannot cope with the extra care and attention the children need.

Yet it should be noted that children are affected in different ways by the drug and by such factors as when and how much of the drug was ingested. As a result, some children who test positive for cocaine in their urine at birth appear normal and behave normally. It is unknown what long-term effects may occur, but some adoptive parents believe the risk is well worth their efforts.

According to researcher Laura Feig, as many as 80% of infants who were exposed to drugs (including other drugs in addition to cocaine) are foster children. Because many have serious medical problems, it has been difficult for social service agencies to find enough foster or adoptive families. (When the infant has only "traces" of cocaine, the infant is much easier to place.) Many prospective foster parents fear taking care of these babies because they fear the infants may also be AIDS-infected, and children with AIDS suffer a broad array of ailments. (There are also people who fear they will contract AIDS from taking care of the infant.)

Individuals who are considering adopting cocaine-exposed infants should request copies of the child's medical record. An in-office review is inadequate, and the couple (or single person) should be able to take the copy of the medical record to their own physician, whether the child is still an infant or is an older child who was exposed to cocaine in utero. (The agency will almost always delete the identities of the birthparents for purposes of confidentiality.)

If the adopting couple are not the child's foster parents, they should also ask to speak to the child's foster parents to learn as much as possible about the child. The prospective parents should also ask the agency for names of local physicians and psychiatrists or psychologists who are knowledgeable in this area.

Help for Cocaine Addicts

Two national organizations maintain toll-free telephone numbers for cocaine addicts to use if they decide to seek help for their addiction. One is the National Cocaine Hotline (1-800-COCAINE), which refers callers to drug treatment programs in their areas. The other is the National Institute on Drug Abuse, Drug Information Service (1-800-662-HELP), which also refers callers to drug treatment programs.

Richard P. Barth, Ph.D., "Educational Implications of Prenatally Drug Exposed Children," Social Work in Education 13 (1990): 130-136.

Nancy E. Chaney, M.D., Jenny Franke, M.D., and W.B. Wadlington, M.D., "Cocaine Convulsions in a Breast-Feeding Baby," The Journal of Pediatrics 112 (January 1988): 134-135.

Ira J. Chasnoff, M.D., Dan R. Griffith, Ph.D., Scott MacGregor, D.O., Kathryn Dirkes, B.M.E. and Kaytreen A. Burns, Ph.D., "Temporal Patterns of Cocaine Use in Pregnancy," Journal of the American Medical Association 261 (March?24/31, 1989): 1741-1744.

Keeta DeStafano Lewis, Barbara Bennett and Nadya Hellinger Schmeder, "The Care of Infants Menaced by Cocaine Abuse," Maternal Child Nursing (September/October 1989): 324-328.

Judith Schaffer, M.A., Cocaine Use During Pregnancy: Its Effects on Infant Development and Implications for Adoptive Parents (Ithaca, N.Y.: New York State Citizens' Coalition for Children, 1988)

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