The notion that babies exposed to cocaine in the womb are born emotional cripples, sentenced to life in a permanent "biological underclass," is just flat wrong, a leading pediatrician said yesterday.
"They are not permanently damaged," said Dr. Barry Zuckerman, professor of pediatrics and public health at the Boston University School of Medicine.
"They are not throwaway kids, and I do not think society should be let off the hook" for the problems and conditions that afflict these children and their families. "We can make a difference in these babies' lives," he said.
With early and comprehensive intervention for the medical, psychiatric and social needs of both mother and baby, these children can be brought back within the norms of other kids who grew up in similar environments, Dr. Zuckerman said.
But only national political leaders can lead an assault on the conditions of poverty responsible for much of the well-documented damage done to poor children through higher rates of prematurity, malnutrition, anemia, lead poisoning and congenital infections.
"We need someone to stand up for families and children," he said. "It has to be us, Congress and local government, but it has to start at the top."
Dr. Zuckerman is a member of the National Commission on Children. His own research has focused on the effects of poverty on children. He also helped develop the Women and Infants Program, which treats poor and addicted women and their babies at Boston City Hospital.
He spoke yesterday to a Rockville symposium on drug-exposed babies, sponsored by the Reginald S. Lourie Center for Infants and Young Children in Rockville and the Montgomery County Department of Addiction, Victim and Mental Health Services.
Recent media images of "crack babies" as brain-damaged wretches unable to concentrate on tasks, tell right from wrong, give or receive love, or control their impulses -- were painted "before we had any scientific data," Dr. Zuckerman said.
That hopeless stereotype led to the labeling of cocaine-exposed infants as "unadoptable . . . denying them just what they needed," he said. It also colored the scientific literature, giving negative findings more visibility.
But after more research, which he still calls preliminary, Dr. Zuckerman said, "what we see are children, like all other children, with an enormous potential to grow. . . . There is no data to show permanent, universal brain damage. I want to take that off the table."
Still, cocaine is a dangerous drug, Dr. Zuckerman said. "It has significant adverse consequences on families and communities. But I don't have any scientific data that shows it causes permanent brain damage [in fetuses]." To the contrary, the research suggests the infants' brains "can recover and do well" if the children are treated early.
Recently published studies of developmental problems among cocaine-exposed babies in Chicago suggested that by age 2, cocaine-exposed babies who received comprehensive psychiatric and social services for themselves and their families had pulled even with healthy babies on psychological assessment tests. Similar results were found in studies of methadone-exposed children.
"If they stay in the program, whether they are narcotic- or cocaine-exposed, it looks like they can and should do well," Dr. Zuckerman said.
More money and more programs are needed to address such issues as the mother's addiction, dysfunctional families, poor parenting skills, the mother's own history of neglect and abuse, social isolation, chaotic homes, self-neglect and much more.
Cocaine-exposed babies do seem to be smaller than their non-exposed peers, Dr. Zuckerman said.
The babies of cocaine-using mothers have been found to average 1 pound lighter than babies born to non-users. They also are smaller on average, with smaller head sizes, which may reflect smaller brain size.
But cocaine may be responsible for only a fraction of that difference. The mother's use of cigarettes, alcohol, marijuana or opiates, all of which are common among women who use cocaine, can have the same effects and may play a larger role, Dr. Zuckerman said.
Higher rates of sexually transmitted disease, a lack of prenatal care, and smaller weight gains during pregnancy among cocaine-using women may also contribute. "We're talking about lifestyles and the need for comprehensive intervention," he said.