Good news about cocaine babies

By Charles Schwarzbeck

Alexis and her 2 &1 halfyearold son, Kenny, greeted Esther, a public
health nurse, at their home. Esther would later explain that "I expected
a disorganized, filthy home, with a dull, lethargic baby, who found
little to laugh about. I've seen a lot of cocaine babies, and the rule is
that their homes and development are predictable.' handicapped toddler
and residential chaos!"

Instead, Esther found a happy home. "Alexis certainly wasn't loaded,"
Esther would later explain, "and she seemed rested and engaged." She
played with hand puppets with Kenny naking believe they were buyiny ice
cream cones.

Alexis asked, "Do we have to give money for ice cream?" "Is ice cream
cold?" "Does Ice cream tickle our noses?" "What's your name, little boy?"
"Ice cream!" Kenny yelled. They both laughed.

At Esther's recommendation, I visited with Kenny and Alexis the next
day. There I witnessed good results of Alexis' effective drug treatment
program. I have known Alexis, an innercity 19yearold mother, since her
fifth month of pregnancy. Then she was a regular crack user. We feared
that her newborn's prospects would be grim.

Until recently, much of the professional literature described delayed
and handicapped outcomes for cocaine babies. We expected these children,
when they became toddlers, to be developmentally behind, lethargic. and
unable to play in imaginative and makebelieve ways. We expected their
mothers to be withdrawn and not invested.

We have found that the best way to look at how a toddler is growing up
is to look at the play that goes on between the at home parent and the
2yearold. The parent normally should create interesting. entertaining
play that cultivates intellectual progress. Our experiences in the past
with mothers who used cocaine when they were pregnant typically showed us
that they couldn't bring imaginative, entertaining, constructive play to
their babies and toddlers.

Recent studies are reporting that toddlers who were cocaineexposed
before birth do not appear to be neurologically abnormal, compared with
toddlers who were not exposed to cocaine! Further, their mothers,
contrary to longheld predictions, are able, once recovered from drug
addiction, to bring imaginative, energetic, constructive play to their
young child.

A baby's resiliency seems to overcome and avoid lifelong brain damage
from prenatal cocaine exposure even when the child is obviously affected
and delayed In the first month of life. (Kenny looked delayed and
unresponsive at 3 weeks after birth).

At least as important, preterm addicted mothers seem to be able to
recover enough, through effective substance abuse intervention and
rehabilitation, to learn how to get down on the floor and energetically
engage their little ones. This is in contrast with the typical withdrawn
and/or disciplinecontrolled focused interchanges that were frequently
seen with cocaine moms a few years ago.

How can we explain these promising findings that are very different from
the sad, pessimistic outlooks of not so long ago? What conclusions can we
draw, about the effects of preterm, cocaine exposure on a young child's
nervous system?

Four years ago, at the biannual meetings of the Society for Research in
Child Development researchers from Toronto and New Orleans showed that a
significant number of elementary school children exposed to cocaine
prenatally functioned within average Intellectual ranges. Previously, it
had been predicted that neurologic damage caused by the mother's,
prenatal cocaine addiction would forever handicap learning and school
achievement in the offspring. How, we asked, was that many of the
children were able to function normally inspite of their insult? It now
seems that the quality

of mothering in infancy is the crucial factory in determining whether
cocaineexposed babies will be able to recover and live normal lives. In
other words, if a pregnant woman is able to undergo drug intervention,
move away from cocaine use and recover from her addiction and
subsequently mother in normal ways, there is a good chance her toddler
will develop normally.

We are thus left with two conclusions:

~ 1. These findings show that young children can be impressively
resilient. These habies' young nervous systems can evidently recover, and
get on with normal development, in spite of their toxic months in the
womb.

~ 2. Immediate, aggressive, substance abuse intervention is crucial for
pregnant women using cocaine. Mothers who can overcome drug use can go on
to support their baby's development and participate in norinal play with
their thriving 2year old!

Dr. Schwarzbeck is assistant chrinical professor of psychiatry at the
Urniversity of British Columbia and is on the faculty of the University
of Washington Medical School. He can be reached at schwerzbeck@aol.com