Meth Kids: Heartland’s Tragic Tale

“F/U. DAB.” Follow-up. Drug-affected baby. Those cryptic notations on Rizwan Shah’s appointment schedule once invariably signaled that the child in the examining room was born of a big-city, downtrodden woman who’d gotten pregnant while abusing crack cocaine.

In the last three years, however, the pattern has changed. Now, the pediatrician’s patients at Blank Children’s Hospital are traveling for hours to get to the clinic from places like Jamaica--population 232--to the northwest, and from a hamlet near Creston on Route 34, halfway to the Nebraska border.

Children of the working class, they’ve absorbed a different drug in the womb: methamphetamine, also known as meth, speed, crank and ice. By whatever name, it is “small town, big time” in Iowa, Shah said, fanning out from distribution centers in Des Moines, Marshalltown to the north and Muscatine on the Mississippi River.

The hypersensitive meth babies are a mournful bellwether of the epidemic crank use sweeping the Midwest, fed largely by the clandestine labs set up by Mexican cartels in Riverside and the San Joaquin Valley. Once stereotyped as a “biker drug,” methamphetamine has a broad new consumer base among blue-collar workers who want to stay awake and teenagers seeking to lose weight, in addition to people simply seeking a high. It is strongly addictive.

Little is known among pregnant users about the effects of their behavior, as little is known by physicians. Sometimes rural doctors who encounter meth infants don’t even recognize the problem. Drug use is not something most new mothers announce and, while certainly not unknown on the prairies and plains, law enforcement authorities say it hasn’t been so prevalent in this territory before.

By virtue of her drug-baby experience and her location in the heart of crank country, Shah is one of the few pediatricians to study meth’s effects on children.

One of those children is Bryce Matthias, 4 months old, who can’t stand being tickled and needs the music turned down low.

Another is Harley Fouse, 17 months, who shrieks at the sight of turning ceiling fans and must play with a shirt to feel its texture before allowing himself to be dressed. (The whole changing process takes 20 minutes or more.)

A third is Rachel Pender, almost 2, in an upswept ponytail fastened with a teddy bear barrette. She is so brain-damaged that she will likely never talk; with luck, she may walk with leg braces by the time she’s 6.

Problem Is Most Striking in Midwest

These poisoned children have counterparts in California, from San Francisco to San Diego, and in Utah, Florida and Hawaii. But the problem is most striking in Iowa, Missouri, Nebraska, South Dakota and Kansas. Those states form a predominantly rural region at the center of the great national highway routes where methamphetamine has become “the drug of choice,” as the U.S. Drug Enforcement Agency reported last year.

Methamphetamine is an illegal stimulant like cocaine, lower in price but producing a similar rush. It also produces high-strung children similar in many ways to crack babies.

But having tracked 375 drug-affected infants since 1989, Shah has noted important differences with meth. One is a tendency to sleep nearly all the time during the first month of life, so deeply that the jaws must be pried open to get the baby to suck. Meth babies also exhibit a pronounced aversion to being touched on the head or feet.

And just as meth powers a high hours longer than cocaine’s, Shah suspects the drug’s effects on developing fetuses will prove more long-lasting as well. Unlike cocaine, meth is toxic to brain cells because it sharply reduces levels of the neurotransmitters dopamine and serotonin, which regulate motor skills and moods.

Jeannie M. Sims, a Des Moines child psychologist, counsels a 3-year-old who screams for up to 45 minutes each time she is wiped after using the toilet. Another client, a 4-year-old boy, still shakes whenever he wakes up. Shah has a 5-year-old whose hand tremors make it impossible for him to hold a crayon.

“You think of a cocaine baby as the worst that it could be,” Sims said. She paused, then added simply, “They’re not.”

10% of Iowa Babies Said to Be Affected

The numbers are nebulous. A 1992 hospital survey by the National Institute on Drug Abuse found that just 4,500 of 203,000 drug-exposed infants across the nation had been affected by methamphetamine. But that sample was taken before meth use took off and is “clearly out of date,” said NIDA pharmacologist Jerry Frankenheim.

Shah, who chairs Iowa’s Council on Chemically Exposed Infants and Children, said that in her state alone, about 4,000 newborns a year are affected by drugs--10% of Iowa’s babies, up from 3% to 6% five years ago. And in 90% of today’s cases, that drug is meth.

At the University of Nebraska, pediatrician Lynn Willett said, meth babies are delivered at the rate of “a couple a month.” In Jackson County, Mo., about 30 expectant or new mothers are enrolled in a 150-person meth addiction service program run by an agency called Comprehensive Mental Health. “I think we’re seeing the problem, but it’s not being identified,” said the program’s coordinator, Loretta Jasper.

“The number of kids who are coming through [for counseling] is horrendous. Behavior control, anger, attention deficits.”

Said Sims in Des Moines: “I never used to see any” patients who’d been exposed to methamphetamine. “Now, I just keep thinking, ‘Oh, I can’t believe it. Another one.’ ” Even the older children, born before the drug swept in, talk about their pregnant mothers who are snorting, smoking or injecting it.

Predicting the meth babies’ progress over a lifetime is simply not possible. Fears during the 1980s of hyperactive crack babies flooding inner-city schools were never borne out. Children are resilient, researchers concluded; brains eventually rewire themselves.

And each child responds so differently. There are so many variables: The amount of meth consumed, the point in the pregnancy at which the child was exposed, other drugs that may have been added to the mix, the baby’s genetic makeup and the home environment, to name a few.

Perhaps in the long run, the majority will heal and turn out just fine. But even in that best-case scenario, most families of meth babies are in for years of parenting that they will likely find--in an understatement--difficult.

Worst of all is the information void. Six months ago, Richard Spooner, a computer firm manager from Carlsbad in San Diego County, posted a message to several adoption chat groups on the Web, asking if anyone could offer guidance about methamphetamine-affected babies.

He and his wife, Anne, had adopted a heroin-addicted girl and weaned her off methadone at the age of 5 months. Now they are in the process of adopting a 17-month-old boy who tested positive for meth at birth. Their prospective son had double pneumonia and multiple infections, and he still shakes upon awakening. Although hopeful about his future, the couple want to know what else to expect.

They got no responses at all.

“Then we tried the universities and national agencies,” Anne Spooner said. “There was no literature. I was really struck by that.” She was interested for professional reasons too. As a social worker who deals with developmentally disabled children, she has noticed methamphetamine showing up in case histories on the job.

Alfred Heller, a University of Chicago neurobiologist, is one year into a five-year study of the effects of methamphetamine on fetal tissues extracted from mice and nurtured in culture. He has seen seven days’ worth of meth cut dopamine levels by 80%--in the range shown by sufferers of Parkinson’s disease. When the meth is removed, the cells recover, but they never catch up to the development of unexposed cells.

“You’ve got a potential permanent problem,” Heller said. “But we don’t have the answers yet.”

Some Meth Users See Little Danger

The lack of answers may be why Katherine Irwin, a doctoral candidate in sociology at the University of Colorado, found pregnant meth users to be more nonchalant about the drug than pregnant users of heroin or cocaine. In 1995, Irwin handed out fliers in San Francisco seeking expectant mothers who used street drugs and was surprised to find some who sought their highs from meth.

The crack smokers and heroin snorters talked sorrowfully about the strength of their addictions and the damage they anticipated to their children. “There’d been so much about crack babies in the papers,” Irwin said.

By contrast, she discovered, crank users tended to feel “it was just what got them going, their morning cup of coffee,” and wouldn’t inflict much harm.

Shah too searches medical literature every few months and has yet to find articles on meth kids. At least those who find their way to her clinic have her experience to lead them.

“Without her, we wouldn’t have known what to do with him,” said Doreen Terrell of Des Moines, whose niece is Harley Fouse’s mother.

Terrell, a proofreader for the Iowa Legislature, and her husband, a highway construction worker, took in Harley and his bewildered father, Roger Fouse.

Fouse, 36, received his infant son at his farm equipment repair shop from the local child services agency. Harley’s mother--Fouse’s 21-year-old girlfriend--could not take care of the boy, he was told. She had used meth while pregnant and had exposed the baby. He should have Shah examine his son.

Fouse was no stranger to the drug. A discolored patch on his belly serves as a reminder of the time he spilled a pipe. But he’d only sampled it, he said, in an effort to stay alert during the harvest rush, and he’d had no idea his girlfriend was using it.

He certainly didn’t realize what he and Harley were in for.

It takes all three of the adults who live with Harley to handle him.

As a newborn, he slept so much he hardly ate, slowing his growth. “Then he woke up,” said his father, “and he hasn’t gone back to sleep since.”

Harley’s muscles were so tight he felt “like a piece of steel,” said Dale Terrell. He shook uncontrollably. He hated the touch of water and would scream when anybody tried to bathe him.

Shah advised them to loosen Harley up with frequent massages but to avoid stroking his head. She warned them about touching his feet: no shoes or socks, she said.

She explained that, to Harley, sounds seem louder, lights brighter, textures more extreme because of his prenatal exposure.

Why, the family asked, does Harley scream when they reach toward him? Because, the doctor guessed, he thinks your hands will go right through him.

Understanding Harley’s world has helped them stay patient through his all-day, all-night bouts of hysterical insomnia. “Sometimes,” sighed his father, “all three of us are on the couch rocking.” For months, even handing the baby off like a relay baton, the grown-ups averaged about an hour of sleep apiece.

Knowing about his sensory overload helped them figure out how to feed him. Shah explained he chooses food by texture, not taste. “He likes squishy things,” Doreen Terrell said. If he doesn’t like what he’s eating, everyone knows it. He throws it across the room.

For what seemed like forever, they couldn’t take Harley anywhere. He seemed most comfortable in the Terrells’ bedroom, with the television on low, the lights out and the door shut. And he liked to sit in the garage with his dad.

Now, he’s a veteran of several long car trips--Shah cautioned the family to stop every 50 miles for at least an hour. It took six hours, instead of the usual 2 1/2, to drive to Kansas City, but they made it.

Child’s a Regular at Coffee Shop

And these days, Harley is a regular visitor to a coffee shop around the corner from his house, where the tolerant staff knows to seat the family in a near-deserted back room.

There, one recent evening, Harley sat quietly for a while in his father’s lap, Fouse’s grease-darkened fingers curled protectively around the small boy’s waist. Then the child squirmed off, screamed and ran into a wall before Fouse could stop him. Later, Harley stood up in a booth and hit his head on a hanging lamp.

“Just because he looks OK,” Doreen Terrell said softly, “doesn’t mean he is.”

The next day, a retired teacher brought her 2 1/2-year-old granddaughter from southwest Iowa for an appointment with Shah. The young patient was decked out in a red-and-white striped dress complemented by a pair of red tights.

The girl’s mother, in a telephone interview, said she stopped using meth when she found out she was pregnant, at four months along. She had no explanation for the child’s positive test at birth.

The girl broke out in tremors at her 4-week-old checkup, and again at 6 months. The shakes are mostly gone now, but her muscles are still tight. Her congenital labial fusion, which makes urination painful, has not improved.

She lay back on the examining table, clutching a stuffed giraffe.

“Does she have any words?” Shah asked.

“No words,” the grandmother replied.

“I would like to have a speech evaluation,” Shah said.

On the way out, the grandmother paused by the elevator. “I don’t think it’s really hurt,” she said of her daughter’s meth use while pregnant. “Her kids all seem to be smart.”

Shah shook her head when she heard about that remark. “Major denial,” she said.

After Shah, 56, moved from her native Pakistan to Boston, she relocated again to Des Moines a quarter-century ago because of its reputation as a wholesome place to raise kids. (She has three of her own.) She treated ear infections and sore throats like everyone else, until the first crack baby crossed her path in 1989.

Now her sad and busy practice concentrates on children who’ve been let down by grown-ups in their lives: the sexually and physically abused and the drug-exposed. A matronly woman given to linen suits--often with a hem askew or a wayward tongue depresser on her shoulder--she is a familiar sight at hospitals all over the state that call her to consult on these most troubling cases.

Her appointment book traces meth’s route through the state. First, the children came from towns along Interstate 80. Now they come in clusters from U.S. 30.

The DEA’s resident agent in charge, David Lorino, said Shah’s observations make sense. Mexican cartels have sent operatives to small cities where they can blend in with burgeoning Latino populations attracted by meatpacking jobs. Wrapped in cellophane and duct tape, tucked into false gas tanks or stashed in glove compartments, the powder rides the highways from the West Coast to Iowa.

Busts of meth manufacturers are way up locally, but Lorino scornfully dismisses them as “Beavis and Butthead labs”--leading to one-pound meth confiscations rather than the 20- and 40-pound seizures from the California exporters. Even in Independence, Mo., a hotbed of lab busts nationally, narcotics officers have noticed a West Coast influx in the last six months.

“It’s been an untapped market,” Lorino said. “Now it’s a big-time market.”

Given this backdrop, Mary Jankowski, adult programs supervisor at a halfway house run by a Des Moines order of nuns, was hardly surprised when she tallied up the drugs taken by mothers who’ve gone through rehab to try to keep custody of their babies.

Of the 33 who’ve lived at the House of Mercy since 1990, 23 had children that tested positive for meth.

In the day-care center, the teachers use Shah’s techniques, dimming the lights, swaddling the youngest, keeping the noise level as low as possible. “It’s helped,” Jankowski said. One instructor took lessons in massage, a skill she passes along to the moms.

Yet the news is still filtering out.

An experienced foster mother cradled a napping 2-week-old boy in her arms at Shah’s clinic, reporting that the hospital where he was born--in Webster County to the north--found “15,000 nanograms of cocaine” in his urine.

Shah frowned. “That’s awfully high for cocaine. How is he sleeping?”

“If anything, he’s too sleepy,” the foster mother said. “We got him on Tuesday and we didn’t even know the kid had eyes till Saturday.”

The baby’s arms and legs shook.

Shah asked another doctor to switch off the lights. The baby, still sleeping, calmed.

“Are you sure it was cocaine?” she wanted to know.

“Well, the social worker says the mom was smoking crank,” the foster mother answered.

“Crack or crank?” Shah pressed. The foster mother wasn’t certain.

Shah had her suspicions. “I think,” she said, “we’ve got another one.”