‘Crack Babies’: The Epidemic That Wasn’t

By SUSAN OKIE
Published: January 26, 2009
NY TIMES

BALTIMORE — One sister is 14; the other is 9. They are a vibrant pair: the older girl is high-spirited but responsible, a solid student and a devoted helper at home; her sister loves to read and watch cooking shows, and she recently scored well above average on citywide standardized tests.

Dr. Harolyn M. Belcher, a pediatrician, doing a checkup on Cornell Wright, a young patient.

There would be nothing remarkable about these two happy, normal girls if it were not for their mother’s history. Yvette H., now 38, admits that she used cocaine (along with heroin and alcohol) while she was pregnant with each girl. “A drug addict,” she now says ruefully, “isn’t really concerned about the baby she’s carrying.”

When the use of crack cocaine became a nationwide epidemic in the 1980s and ’90s, there were widespread fears that prenatal exposure to the drug would produce a generation of severely damaged children. Newspapers carried headlines like “Cocaine: A Vicious Assault on a Child,” “Crack’s Toll Among Babies: A Joyless View” and “Studies: Future Bleak for Crack Babies.”

But now researchers are systematically following children who were exposed to cocaine before birth, and their findings suggest that the encouraging stories of Ms. H.’s daughters are anything but unusual. So far, these scientists say, the long-term effects of such exposure on children’s brain development and behavior appear relatively small.

“Are there differences? Yes,” said Barry M. Lester, a professor of psychiatry at Brown University who directs the Maternal Lifestyle Study, a large federally financed study of children exposed to cocaine in the womb. “Are they reliable and persistent? Yes. Are they big? No.”

Cocaine is undoubtedly bad for the fetus. But experts say its effects are less severe than those of alcohol and are comparable to those of tobacco — two legal substances that are used much more often by pregnant women, despite health warnings.

Surveys by the Department of Health and Human Services in 2006 and 2007 found that 5.2 percent of pregnant women reported using any illicit drug, compared with 11.6 percent for alcohol and 16.4 percent for tobacco.

“The argument is not that it’s O.K. to use cocaine in pregnancy, any more than it’s O.K. to smoke cigarettes in pregnancy,” said Dr. Deborah A. Frank, a pediatrician at Boston University. “Neither drug is good for anybody.”

But cocaine use in pregnancy has been treated as a moral issue rather than a health problem, Dr. Frank said. Pregnant women who use illegal drugs commonly lose custody of their children, and during the 1990s many were prosecuted and jailed.

Cocaine slows fetal growth, and exposed infants tend to be born smaller than unexposed ones, with smaller heads. But as these children grow, brain and body size catch up.

At a scientific conference in November, Dr. Lester presented an analysis of a pool of studies of 14 groups of cocaine-exposed children — 4,419 in all, ranging in age from 4 to 13. The analysis failed to show a statistically significant effect on I.Q. or language development. In the largest of the studies, I.Q. scores of exposed children averaged about 4 points lower at age 7 than those of unexposed children.

In tests that measure specific brain functions, there is evidence that cocaine-exposed children are more likely than others to have difficulty with tasks that require visual attention and “executive function” — the brain’s ability to set priorities and pay selective attention, enabling the child to focus on the task at hand.

Cocaine exposure may also increase the frequency of defiant behavior and poor conduct, according to Dr. Lester’s analysis. There is also some evidence that boys may be more vulnerable than girls to behavior problems.

But experts say these findings are quite subtle and hard to generalize. “Just because it is statistically significant doesn’t mean that it is a huge public health impact,” said Dr. Harolyn M. Belcher, a neurodevelopmental pediatrician who is director of research at the Kennedy Krieger Institute’s Family Center in Baltimore.

And Michael Lewis, a professor of pediatrics and psychiatry at the Robert Wood Johnson Medical School in New Brunswick, N.J., said that in a doctor’s office or a classroom, “you cannot tell” which children were exposed to cocaine before birth.

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