A neonatologist who led a long term study of babies exposed to crack cocaine in utero has reached a conclusion she and her colleagues did not expect: poverty harms children more than prenatal cocaine use by their mothers. And among the cocaine-exposed, there are some kids who flourished, apparently because they experienced nurturing and lasting relationships with adults despite family poverty and addiction.

Remember the horrifying "crack baby" stories in the 1980s and 1990s? The nation's health specialists and social pundits voiced dire warnings of a generation of children doomed to deficient intelligence and physical disability and deformity. TV, magazines and newspapers spread fearful predictions of damaged babies growing into a huge population of defective children and adults that would overwhelm social services and cost taxpayers billions. One newspaper column envisioned a "human plague almost too horrible to imagine." A prominent college president even suggested "crack babies won't ever achieve the intellectual development to have consciousness of God."

Cheap smokable crack cocaine poured into cities across the country in the 1980s. A study in 1989 found that one in six newborns in Philadelphia hospitals had mothers who tested positive for cocaine. Hallam Hurt, MD, neonatology chair at Einstein Medical Center, organized a study of 224 babies born at Einstein between 1989 and 1992, half of whom had prenatal cocaine exposure, and half of whom had not. All the babies were from low income mostly African American families. All were full term or nearly full term, and all their mothers were serious users, with an average of 99 days of crack use during their pregnancies. Federal funds and contribution from the Einstein Society allowed the study to continue nearly 25 years. The research is described in an NPR RadioTimes discussion and in a Philly.com story by Susan FitzGerald.  

Each child's development was evaluated at six months, then regularly until early adulthood. Dr. Hurt, who moved her team to Children's Hospital of Philadelphia in 2003 and is now a professor of pediatrics at the University of Pennsylvania, found virtually no differences between the children who had been exposed to cocaine and those who had not. She and colleagues did find that both groups lagged behind middle class kids the same age. So what influence besides cocaine was at work? The team discovered poverty was "the elephant in the room."

"Finding that poverty is a bigger factor than drug use is a really tough finding," Dr. Hurt said in the NPR discussion. "It's much simpler to say that the drug is the problem." It wasn't a popular finding either, she said, because poverty is more complex and much harder to address, as are the cumulative effects of exposure to violence and deprivation that leave kids with post traumatic stress, more anxiety, lower self esteem, and less resilience.

"We began to hear stories when kids came in for testing," Dr. Hurt said. "We'd hear about kids seeing their mother chased by someone with a knife." Measuring exposure to violence, the team found that by age seven, 11 percent of children had seen someone killed; 81 percent had seen someone arrested, 74 percent had heard gunshots, 35 percent had seen someone shot, and 19 percent had seen a dead body outside.

An article in the journal Pediatrics in May described a study led by University of Maryland researcher Maureen Black, PhD. Evaluations of more than 5,000 children between the ages of 11 and 17 whose mothers had used cocaine during pregnancy found most developmental measures within normal ranges. That study too concluded the impact of violence and social environment outweighed cocaine exposure. Updated findings carry messages for medical professionals and the media. 

A college senior studying animal husbandry and business told Radio Times of her family's strengths, values and the good grades she and her siblings earned despite her mother's prenatal and continuing cocaine addiction. Listen to Radio Times here. 

Inviting Everyone: Healing Healthcare through Positive Deviance

by Curt Lindberg, Prucia Buscell, and Arvind Singhal

Kindle Edition ~ Release Date: 2013-07-26

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