Drugs and the Lives of Children: Prenatal Exposure Soars in U.S.

About 400,000 children exposed prenatally to drugs will have been born in the United States this year alone.

One-third of them will have been delivered prematurely and may suffer complications related to their premature birth.

A great number require treatment for such sexually transmitted diseases as syphilis and gonorrhea.

A small percentage will be infected with the AIDS virus.

For such children, these complex medical problems represent just the beginning of their struggle to survive in a world where professionals only now are learning about the special needs of infants who have been exposed to drugs.

Over the past nine years, the UCLA Department of Pediatrics has identified several hundred infants who were exposed prenatally to drugs, and the staff has worked closely with the parents of these children. Chemically dependent parents present professionals with a variety of profound challenges.

In the first place, addicts have a single priority. Addiction by its very nature makes a person concerned primarily with his or her next fix, not with the needs of family members.

Chemically dependent parents are characterized by fluctuating altered mental states. While high on crack cocaine, heroin, amphetamines or PCP, a person’s behavior may shift rapidly among feelings of superhuman ability, paranoia and the urge to engage in physical violence. Once this high evaporates into a low, substance-abusers experience periods of extreme depression, lack of concern, hallucinations or extreme cravings for the next fix.

This “better living though chemistry,” needless to say, does not create an appropriate environment for child-rearing.

Children of substance-abusing parents present their own particular challenges. Newborns exhibit symptoms of prenatal exposure to drugs and are not easy to care for. They can be extremely irritable or unusually lethargic, have poor sucking abilities (resulting in feeding problems) and sleep for only very short periods of time.

When a suspected drug-affected child is born, a hospital’s decision to proceed with a urine-toxicology screening test, to determine whether or not illicit substances are present in the child’s system, may be based on the mother’s history of drug addiction, any behavior that is suggestive of acute drug intoxication, needle marks or the newborn’s symptoms of drug withdrawal. A positive urine screen indicates that the mother has used drugs within three to four days of the infant’s birth.

When these children reside with their addicted parents, child abuse and neglect are not uncommon occurrences. Yet when drug-exposed infants are placed with other care-givers--including extended family members and foster parents--the adults often become worn out by the demanding and continuing specialized care required.

As the children mature, the deleterious effects of drugs upon the developing brain become more and more obvious. The notion that these infants simply “go cold turkey” and withdraw from prenatal addiction has been discredited in light of recent findings. Studies at UCLA show very few children escape the consequences of prenatal drug exposure, even when placed in nurturing and responsive home environments. Researchers have seen a range of developmental problems, from fetal death to mental retardation to subtle behavioral problems to normalcy. The majority of these children fall into the “subtle behavioral problems” category.

Several years ago, UCLA noted that many prenatally drug-exposed toddlers were demonstrating slow speech development, increased levels of activity and poor social interactions. To gain a better understanding of the children’s subtle developmental problems, researchers studied the toddlers’ ability to play with toys in an “open field” setting, imposing no limits upon them over a 15-minute time period.

The 18-month-olds selected for evaluation had been exposed primarily to cocaine, but some also had suffered prenatal exposure to heroin, methadone, amphetamines and/or PCP. The comparison group was composed of children born pre-term, weighing less than three pounds and who had not been exposed to drugs prenatally. Children in both groups were followed by the UCLA program since birth, had received excellent health care, had been involved in home-based early education services and came from similar socioeconomic circumstances.

There were marked differences between the two groups’ ability to engage in meaningful independent play--which is the way a child intellectually learns. The non-drug-exposed toddlers played as most children do. They pretended to stir food in a pot, talk on a toy telephone or place a doll in a bed. The children in the prenatally drug-exposed group, on the other hand, scattered and batted the toys, picked up toys and threw them down--all without purpose. Their facial expressions appeared flat and joyless and their body language did not demonstrate enthusiasm.

The significance of these observations is not an optimistic one. Children learn through play and creative experimentation. Based on past experience, developmental specialists recognize “soft neurological signs” that foreshadow future learning difficulties and social problems. The prenatally drug-exposed children exhibited these indicators.

Never before has our society encountered such large numbers of children who require--and will continue to require--special educational services, and who are likely to experience eventual difficulty in securing employment. Never before has our nation been faced with such large numbers of dysfunctional parents who are unable to advocate for their children. Drug use and sale, acts of violence, incarceration, prostitution, homicide and child abuse--all not uncommon activities in substance-abusing families.

As a society, we have no choice but to provide intensive services for these children and their parents. Physicians, judges, attorneys, social workers, nurses, counselors, psychologists and educators make up the diverse team of professionals who may be needed in these families’ lives.

In many cases, responsibility for the children’s day-to-day care falls upon foster parents, who require and deserve support from the entire cast of professionals. Medical, social-service and educational intervention is necessary to address the children’s complex medical and developmental problems, and to ensure they attain their full potential to lead productive lives.

Ultimately, the taxpayer must pay for the services treating both these parents and their children. The cost is enormous. Yet if we choose not to treat, the eventual price might be so high that it could endanger our economic future--or our economic survival.