Suffer the Little Children What has become of the District's crack babies?

What has become of the District's crack babies?

The headlines were dire, the predictions bleak: In 1989, experts were estimating that 1,500 babies a year in the District were being born to crack-addicted mothers. And countless numbers of the infants were being abandoned at birth, right in the hospital. Images of fragile, premature babies shaking off the effects of in utero exposure to cocaine dominated the nightly news. And the strung-out mom replaced the welfare mother as the public stereotype of inner-city Washington.

At the time, social-service workers said they had never seen anything like it. Even when heroin became an epidemic in the '70s, addicts weren't dropping six or seven children at the door of the city's foster-care agency. But during the first five years of crack, demand for foster care jumped 80 percent. The babies were messed up, too: colicky, jittery, unable to bond, freaked out from too many stimuli. Psychologists made hysterical predictions that these coke-addled babies would never recover.

By 1991, as the first crack babies became preschoolers, doctors were reporting signs of neurological impairment, language delays, and problems with motor skills, spatial relationships, memory, and behavior. Initially, researchers blamed the drug itself for the children's problems. Later, it became clear that separating the effects of crack from the effects of parental neglect or crack addicts' lifestyles and attendant health problems was virtually impossible.

And as the story of crack babies spread, the exact causes really didn't matter much: The addicts' kids had problems, and the city was going to end up paying for them in myriad ways. In 1991, the U.S. Department of Health and Human Services estimated that each crack-addicted baby would cost the state and federal governments more than $11,000 per year just to get from hospital delivery to foster care, up to age 5.

More than a decade after the first crack babies hit TV, the interest in those children has diminished, along with their numbers. The follow-up studies promising to confirm the earlier suspicions about the long-term effects of fetal drug exposure have dried up for lack of funding—and lack of results. After the hysteria over the crack-baby phenomenon died down, sober-minded researchers concluded that cocaine wasn't the lifetime debilitator they had once thought it was. As a result, doctors are no longer so quick to write off addicted babies as lost causes.

But regardless of questions about the physical effects of prenatal crack exposure, the early predictions about the social impact of the crack baby turned out to be not so far off the mark. Today, even as the economy has improved and the crack epidemic has ebbed, D.C. grapples with an increasing number of kids coming into the foster-care system. There's no way of knowing just how many of those kids are children of crack, but social workers suspect that the drug epidemic is one reason that today, some 3,300 kids are in foster care. In 1985, the number was half that.

And although there are no concrete data, anecdotal evidence suggests that large numbers of kids born to addicts are now flooding into the special-education system in D.C. public schools as they get older. "It's amazing how many kids are coming into special ed," says one attorney who represents children in need of special education. "It's scary."

The attorney, who, in order to protect her clients, doesn't want to be identified, says that these children suffer a host of problems—attention-deficit disorder, allergies, asthma, and a significant amount of mental retardation—many of which she knows are related to their parents' crack use. "I have a client who is 12, who stayed in the hospital in detox for a while [at birth]," she says. "His mom said he was born a 'healthy crack baby.'" The child has average intelligence but huge neurological problems. He also can't read.

Others among her clients have set fire to other children. One family got kicked out of a shelter because of the kids' behavior problems. "Nobody in the public schools is prepared for this," the attorney says.

Part of the enduring problem is that the troubled children far outnumber the addicts and other family members who might be able to care for them. Children's advocates wryly refer to crack as a "fertility drug," because addicts tend to have so many children.

It makes sense, really. The crack whore, one of the enduring caricatures of the crack era, is not merely a creature of legend. For whatever reason, crack seems to be largely a woman's drug. And women addicted to crack frequently trade sex for a high that makes them forget about food, forget about hungry children at home, forget about the risk of AIDS. Why on earth would they stop to remember birth control? And although Medicaid pays for births, it does not cover abortions.

One lawyer says she routinely represents families with six, seven, nine, 13 children—all born to crack-addicted mothers. Tom Wells, executive director of the Consortium for Child Welfare, adds that although there are no firm figures yet, lingering effects of crack may be the reason that the foster-care system now sees huge sibling groups—five or six kids—coming in to the system neglected or abused.

Walk into Annice Smith's living room and you can see firsthand what's happened to the crack babies. Every time her drug-addicted daughter had a baby, Smith says, she would make the trip down to D.C. General Hospital to bring the child home to her two-bedroom subsidized apartment. Today, Smith shares the place with her daughter's seven children. (All the names have been changed to protect the privacy of the children.)

Smith's daughter died of AIDS a few years ago. By that point, Smith had already given up her D.C. Housing Authority job to make time for the kids. Smith says sometimes she has to hide in the bathroom just to get a few minutes of peace. But she knows her grandchildren are better off because of her. "If my daughter had raised these children, half these kids would be abused," she says.

The children range in age from 6 to 17. The last five children came in rapid succession when their mother switched from heroin and PCP to crack. Smith has no idea who some of the fathers are. But she knows that her grandchildren are everything the experts predicted.

Born in 1983 when his mother was barely 19, Tyrone, 17, the oldest child, is in special education at a private school. He seems to be doing fairly well compared with the rest of the kids.

Lucinda, 15, born while her mother was living in a homeless shelter but before her mother's addiction became chronic, is bulimic and in therapy. Darryl, 12, is mentally retarded—the product, Smith says, of his mother's PCP use. He is also psychotic and on increasingly large doses of three different psychotropic drugs.

Rudy, 10, can be the most trouble, despite his curious smile and boyish mannerisms. Prone to outbreaks of violence, Rudy breaks legs on tables and chairs—which explains why his grandmother is sitting in an aluminum-frame lawn chair. He'll throw things off the dresser onto the floor and break mops and brooms. He is on three different kinds of medications to calm him down, including Risperdal, a potent adult drug usually prescribed to treat schizophrenia. Rudy sometimes grabs his penis and hurts himself and is so unpredictable that he can't go outside alone. His father has 10 other children and once, Smith says, tried to kill the father of Smith's youngest granddaughter—in front of the children.

David, 9, is withdrawn and depressed, and doctors suspect he may be psychotic. He won't shut the bathroom door anymore because he has started seeing things that aren't there. Because he often vomits after eating, it took nearly two years for teachers at a special-education school to get him to eat an apple. Anxious and occasionally violent, David recently took a knife to school and said he was going to kill his teacher.

Samantha, 8, is withdrawn and cries frequently. Smith says Samantha doesn't want to go to school and picks her lips all the time—a common tic among kids born crack-addicted. She also has health problems that include eczema, bronchial problems, allergies, and asthma.

Minnie, 6, was born in jail, HIV-infected. The HIV doesn't show up in tests anymore, but Minnie is withdrawn and has a learning disability. She's also prone to outbreaks of violence, says Smith, who notes that when Minnie's brothers start harassing her, "she'll bust them upside the head."

On one wall of her living room, a large wipe-off calendar is filled from top to bottom with all the various therapy and doctors' appointments to which Smith ferries the children every week—without a car. Because the children are all hypersensitive to noise and food, Smith has to make three different meals three times a day. With so many mouths to feed, she runs up grocery bills of almost $900 a month.

The kids aren't allowed to operate anything because they tend to become a danger to themselves. Rudy once put cookies in the microwave and burned them because he didn't want any of the other kids to have any. When he took the package out of the oven, he burned

his fingers.

Cooped up in a two-bedroom apartment with so many behavioral problems, the kids also tend to beat on each other fairly regularly, as kids will do. Now that the boys have gotten so big, "I don't interfere when they start fighting, because I don't want them to hurt me," Smith says.

Caring for all these troubled kids is a Herculean job—and an expensive one. Five of the kids are in private special-education schools. Their combined tuition costs the District government $141,000 a year, plus nearly $30,000 in transportation to get all the kids to Springfield, Va., Rockville, Md., Northeast D.C., and elsewhere. That doesn't include the $441 in monthly disability payments Smith receives for five of the seven children. Or the Medicaid that covers the therapy sessions for all seven children and their extensive medical care. Or the benefits Smith receives for staying home to take care of all the kids.

Thus, one woman's drug habit now easily costs the government more than $200,000 a year. By the time Minnie graduates from high school—if she makes it—this single family will have cost the city close to $2 million. And that's if Smith can hold them all together and keep them out of institutions or foster care—a daunting task for one 54-year-old woman.

Even with all the additional services the kids are getting, Smith doesn't see a very bright future for any of them. "They're going to always be behind in school," she says. "I see Rudy in jail or a psych jail like St. E's. David will be dealing drugs. I'm hoping Minnie will survive, but she will probably follow in her mom's footsteps. Sammy might make it."

Smith says that in her weakest moments, she gets angry at her late daughter. "Sometime I look at her picture and I get mad and wonder what she's done to me," she says. "I used to be against abortion. Now I'm not so sure."

But Smith also says her situation isn't really that unusual: "I got a girlfriend, she's raising her daughter's babies. Four children are all drug babies. She just had to pick up one from the hospital last week."

Not all the children of crack are doomed to a future of prison and mental institutions, of course. The luckiest ones were those babies adopted right out of the hospital and spared the trauma of their mothers' lifestyles. Geraldine White (not her real name) adopted a little girl she brought home at three weeks from D.C. General Hospital.

Keisha was born exposed to cocaine and also HIV-positive. Her birth father died of AIDS, and her mother is homeless and still using drugs. Keisha has four siblings, two living with an aunt and two with a grandmother. When Keisha was born HIV-infected, family members decided they just couldn't take on the additional emotional burden of a child who might not live to be a teenager.

So White took her in—one of many foster children she'd cared for over the years. The little girl was in foster care with her for five years before the adoption was finalized. The stable, two-parent home has been a godsend for her. White suspects that the difference between her daughter and other children born to crack-addicted mothers is that her daughter was never neglected. "I think that makes a big difference," she says.

As a baby, Keisha suffered from many of the same problems as other crack-exposed kids. She screamed constantly and had dry skin. As she got older, she had trouble with motor skills, like picking up small objects. But today, White says, her daughter is bright and does well in school. Keisha, who will be 8 in October, no longer tests positive for HIV. The only lingering effect of the drug exposure, White thinks, is hyperactivity: "She just can't sit still. She's picking her nails, picking her sores, picking everything."

So far, though, Keisha has been able to stay off medication, and doctors think she can do so as long as she continues to do well in school. And White has found places for Keisha to channel her energy into something positive. She spent the summer at camp, where she joined the cheerleading group. And cheerleading, White says, is one realm where hyperactivity is a plus. "She did real good with the cheers," she says. CP

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