CRACK BABIES
The Term Serves Them Poorly

With the massive increase in cocaine use in the United States in the med-1980's, a troubling new phase has become part of our vocabulary - "crack babies". This media has seized this catch-phrase and is using it as a shorthand expression of society's frustration and anger in its inability to come to grips with the terrible problem of drug use during pregnancy. Headlines such as "The Crack Children," "Crack in the Cradle," and "Crack Babies: Genetic Inferiors" fill our nation's press. Radio and television networks have devoted many prime-time hours to "crack babies". Even a New York State Senator's admirable investigative efforts, for which I served as a consultant, resulted in monograph with the unfortunate title, "Crack Babies: The Shame of New York".

It is certainly undeniable that cocaine use has soared during the past five years, wreaking havoc on our society. It is also true that cocaine use during pregnancy has dramatically increased, with a 20 fold increase in drug-exposed babies in New York over the past decade. I also know that this cocaine epidemic is linked to transmission of diseases such as syphilis and AIDS from drug-using mothers to their children.

Why, then, does the term "crack babies" trouble me so greatly? First, in my twenty years of research on drug use during pregnancy, I have never before witnessed such media- supported pressure to alarm the nation about the fate of a group of diverse infants. Despite very little firm medical documentation of the effects of cocaine on the newborn infant and young child, the media has already concluded that "crack Babies" are prematurely born, tiny brain-injured, unlovable, unteachable, unreclaimable, and even unadoptable. The media portrays "crack babies" as children incapable of positive learning experiences and condemned to a joyless childhood. If this were true, why would society want to allocate resources to help this unfortunate group of babies? In fact, what is really being presented to the public from ? of interviews with "experts" is a patchwork quilt of untested assumptions, individual impressions, and anecdotal experiences which may or may not stand the test of time.

Although responsible researchers are working actively to answer many questions about these infants, this process of discovery takes time and patience and should unfold in an environment free of political pressure and "media hype". Remember that pediatricians have never before been asked to predict the future of hundreds of thousands of diverse drug-exposed infants who may face a multiplicity of high-risk factors: low birth weight, prematurity, mothers who are frequently poor, malnourished, underprivileged, homeless, battered, lacking prenatal care, alcoholic, and HIV positive. Since each of these factors is known to be associated wit poor infant outcome, it becomes extremely difficult to identify a mother's cocaine use as a single variable which might adversely affect her child.

Second, since science may influence or even determine public policy, bad science may lead to bad public policy. As a consultant to educational planning groups and child foundations, I know the frustration and urgency which they feel as this generation of "crack babies" come towards them. If, in fact, specific medical and educational services are needed for this group of infants, strategies to approach these needs should be based on carefully gathered, peer-reviewed data rather than on "blind men feeling the elephant" impressions which currently predominate.

Third, since most of the media presentations which I have seen target drug use in minority populations, this portrayal contributes to the racial stigmatization of our drug epidemic. It is well known that racially unbalanced urine testing at delivery has given the impression that drug use during pregnancy is largely confined to women of minority groups. Such testing has led to a cascade of interventions, including summary removal of the child from the mother and prosecutions. Drug using women are being prosecuted in a least nine states, including Florida, where I served as an expert witness for the defense for one such unfortunate woman. Since evidence demonstrates that drug use to varying degrees is also prevalent in the white middle and upper classes, I suspect that this prosecutorial approach would be quite different if every baby's urine was tested and subsequent judicial actions taken on a race-blind and economics-blind basis.

Fourth, the term "crack babies" shifts the focus away from real needs of our society which the drug epidemic symbolizes - the need to assure economic and social opportunities to every person in our society. Many programs with such a focus have suffered major cutbacks during the past decade. Expenditures of this sort seem to me a very wise investment in our country's economic and social future. Since we know that programs such as "headstart" work to promote child health, we should bolster these programs as we await information on cocaine-exposed babies to determine whether these programs need specific adaptations for this drug-exposed group of infants.