BOSTON - They are called "a biological underclass," and "a lost generation." Those are just two of the milder name tags attached to the children we have come to believe were permanently damaged by their mothers' use of cocaine.
The posters in maternity clinics conjure up the same image of the prenatally doomed: "Some people who smoke crack never get over it." The schools too have been put on emergency alert: "The crack babies are coming, the crack babies are coming."
Indeed, the phrase "crack babies" and now "crack kids" is shorthand for monster-children who are born addicted. These are the kids destined to grow up without the ability to pay attention or to learn or to love.
But just when the name has stuck, it turns out that "crack baby" may be a creature of the imagination as much as medicine, a syndrome seen in the media more often than medicine.
Some three years after the epidemic of stories about these children began, some six years after hospitals began to see newborns in deep trouble, researchers are casting doubt on the popular demon of the war on drugs. Like the national panic about child-snatching - putting missing children on milk cartons - that raged until it was tempered by reality, the story about crack babies is in for some revision.
The very phrase "crack baby" is, in any literal sense, a misnomer. Cocaine is rarely taken by itself. It's part of a stew of substances taken in a variety of doses and circumstances. No direct line, no universal cause and effect, has been drawn from the mother's use of
cocaine to fetal damage.
Alcohol and tobacco may do as much harm to the fetus as cocaine. So may poor nutrition, sexually transmitted diseases, and the lack of medical care. Most importantly, it appears that the children born to cocaine-using mothers are not hopeless cases, permanently assigned to the monster track. Dr. Ira Chasnoff, who did some of the original work identifying the problem babies of mothers who took cocaine in combination with other drugs, has done a two-year follow-up study about to be published. It says, in his words, "Their average developmental functioning level is normal. They are no different from other children growing up. They are not the retarded imbeciles people talk about."
This is not, he cautions, a green light for taking drugs during pregnancy. Drugs remain a serious health problem and cocaine specifically contributes to premature birth and small head size. While the children in his study now function normally as a group, they are at risk individually.
But, says Dr. Chasnoff, "As I study the problem more and more, I think the placenta does a better job of protecting the child than we do as a society." The need now is to widen the lens from nature to nurture, and from the environment of the unborn to that of the born.
Another researcher who has taken a responsible second look at the "crack baby" syndrome is Claire Coles of Emory University. She believes these children, labeled by their drug of origin, are in fact "often victims of gross neglect, not brain damage."
The worst damage that drugs may do is to the world a child inhabits after birth. Coles has a collection of horror stories about children growing up neglected, especially by cocaine addicts. One "crack kid" who couldn't concentrate in class was in fact hungry. Another poorly developed "crack baby" was being "raised" by a 5-year-old sister.
The myth of the "crack baby" became a media hit, Coles believes, because, "crack is exotic and happening mostly in `marginal' populations among `bad people' who are not like `us."' It is easier to think about crack than alcohol or tobacco. There is more than a touch of racism in the attention.
We are interested in genes these days and more interested in assessing moral blame. In a time of pitifully few drug-treatment centers for pregnant women, the crack baby panic resulted in a wave of arrests of pregnant women. One of them, Jennifer Johnson, is still awaiting trial in Florida on drug charges.
But perhaps the worst effect of this distortion is the sense of hopelessness dispensed with the title, "crack kid." Hopelessness on the part of mothers, teachers and even the children themselves. As Coles warns, "If a child comes to kindergarten with that label they're dead. They are very likely to fulfill the worst prophecies."
So, no more convenient and empty names. The children whose mothers used cocaine are neither universally nor permanently nor uniquely damaged. The so-called "crack kids" are just a portion of our growing population of children in deep trouble. They are only children, like so many others, growing up with a treacherous mix of nature's and nurture's woes.
If you need a label, call them kids who need help.
(Copyright, 1992, The Boston Globe Newspaper Company)