Babies born to crack-addicted mothers are like no others. Brain damaged in ways yet unknown, they’re oblivious to any affection. How do you care for a baby who hates to be held?
October 18th, 1990
By Ellen Hopkins
Photographs by Mary Ellen Mark
ROUND AND ROUND spins a little girl with silky brown curls and far-apart eyes. “Serena, don't” says Annie, her adoptive mother. Stony-faced, the two-year-old continues her private waltz till she crashes on top of a mound of toys. Her adopted brother, Matt, who's four, materializes by her side. As though the presence of this elfin, coffee-colored child were a cue, Serena, still flat on her back, grasps a block and lobs it at his head.
Contact. Serena chuckles deep in her throat. Matt, felled to the floor, emits a room-swallowing shriek. He will keep shrieking long after Annie, a large, gentle woman whose dark eyes sparkle behind cheap glasses, picks him up and cradles him in her arms. In time, Annie sets Matt on his feet. The toddlers begin to roam, both on aimless trajectories in which the one goal -forward motion- is broken only by dips to pick up toys that are just as quickly hurled back to the floor. Over the course of the next four hours, neither will smile, not even once.
“What about a crack baby?" the social worker asked when Annie first went looking for a child. A single black woman from Brooklyn, Annie had spent twenty years caring for all and sundry in her orbit who were in need. Then, four years ago, at thirty-four, Annie decided the time had come to be selfish - at least selfish by her lights. She wanted a baby. Specifically, she wanted to adopt a healthy baby girl. Annie had no interest in crack babies.
The social worker persisted. “Crack babies are fussy to start," she said. “You may have some sleepless nights. But any long-term problems should be minor." Annie stood firm: A healthy child or none at all. “Please," the social worker finally said. “We're desperate."
And so Annie abandoned her dream of a perfect baby and adopted the only child available, Matt, and then, a year later, Serena - two pretty, mixed-race babies who sprang from bodies that had their own minimum daily requirement for crack.
Four years, six cribs and nine strollers later, Annie and her smash-happy children had endured these among other minor problems: cerebral hemorrhaging, seizures, fluid on the brain, lesions of the brain, atrophy of the brain, countless episodes of apnea (arrested breathing), tremors, crumbling cartilage, not to mention weekly visits to the neurologist, pulmonary specialist, orthopedist, speech therapist, pediatrician and infant-stimulation class.
"I used to think love would solve anything' says Annie. "Love doesn't make a damaged brain whole."
The pictures for this story were taken at a center for drug-exposed children in East Palo Alto, CA. The photo at left shows a recovering addict at home with her children. Her youngest –exposed prenatally- attends the center.
CRACK DAMAGES FETUSES like no other drug. With heroin, for instance, an addiction is created and the baby has to be weaned after birth. Scary as that withdrawal may seem (some babies are killed by it), once it's over, the outlook is reasonably good.
The same can't be said for crack babies. Crack babies aren't addicted as such. But the damage the drug causes, which seems to arise from its ability to constrict blood vessels, doesn't go away. When a pregnant woman uses crack, her baby's oxygen supply is cut off. Doctors speculate that the extent of damage probably depends on the stage of pregnancy. Some addicts say that whenever they smoke crack during the latter stages of pregnancy, the fetus kicks madly, as though in protest of being strangled.
No one can predict the result of that strangulation. The one thing scientists do know is that the fetus's brain is often damaged. And the amount of damage varies wildly. Annie's children, for instance, are certainly far better off than a pair of crack twins who are so impaired they'll never dress themselves. Matt and Serena, however, are far worse off than the children who've been successfully mainstreamed into grade school. But even for these luckiest cases, the long-term prospects are simply unknowable.
Indeed, a heated debate on how far crack babies can go is at the center of all public discussion of their fate. Some adoptive parents and experts who advocate early intervention believe that the sky's the limit for these children -as long as they get the proper care. Attention must be paid! they say. Get out your pocketbooks! A generation can be saved!
Others believe that what's done can't be undone. Therapy, the pessimists argue, won't stop a braindamaged child like Serena from hurling blocks for the next fifty years. Not that the pessimists are opposed to throwing big bucks at the problem. In fact, several prominent specialists are profoundly pessimistic about their subjects' fate. While they push for grants to study crack babies, they continually question why. For them, this is truly a lost generation, and neither love nor money is ever going to change that.
For those in the front lines, the size of the crack-baby crisis has almost overnight become mind numbing. Some studies estimate that each year in the United States, 375,000 babies are born to women who use illicit drugs during pregnancy -some form of cocaine being the primary drug (all forms are harmful to the fetus; the advent of crack just made the drug more accessible).
Since between ten and twenty-five percent of pregnant women admit to using cocaine, this already-bleak estimate may be grossly understated (about 4 million babies are born in the United States annually). And considering the peanut-butter-and-jelly-like affinity that crack and sex have, these numbers will doubtless just grow worse.
Writing off the ostensibly doomed is nothing new. What's especially disheartening about the crack-baby crisis is the speed of it all - nearly everyone appears to have given up on these children the instant anyone first suspected there was anything wrong.
JUDITH SCHAFFER WAS ONE of the first to suspect. A nationally known adoption specialist, Schaffer agreed in 1986 to head up a task force to increase the rate of adoption in New York City. Schaffer soon called a meeting to ask foster-care workers why they thought more children weren't being adopted. Virtually all agreed that most of the existing programs were sound. Schaffer kept pushing, but no one had any answers.
"There is something though that's nagging at us," one child advocate said, almost as an afterthought. "There's something weird about today's babies. We're used to difficult babies -we've seen heroin babies, babies zapped by alcohol, babies whose mothers had no prenatal care. But these babies are ... different. They're burning our foster parents out. We're not sure we even can place them in permanent homes.”
Schaffer asked to see the records of some problem babies. Without exception, all had been prenatally exposed to cocaine. She decided to do some research. “It took me months simply to find the few studies that had been done on these children," she says. ‘Prenatal cocaine exposure wasn't even generally acknowledged as something to be avoided then. But by the time I finished my research, I was convinced that crack babies were the most serious problem the city had ever faced.”
By the beginning of 1988, Schaffer had pulled together a doozy of a report loaded with depressing projections and recommendations as to what the child-welfare system could do to ease the pain. "I took for granted that my crack-baby report would cause a stir," she says. Schaffer pauses, then beams with sunny cynicism. “I should have remembered lead."
Nearly twenty years earlier, Schaffer had been asked by the New York City councilman Carter Burden to assess the incidence of lead poisoning among inner-city children. The link between eating leadbased paint chips and severe brain damage had only just been established, and Burden was trying to pressure Mayor John Lindsay into repairing crumbling tenements. Schaffer did a survey of a small area in Harlem. More than half of the children had dangerously high levels of lead.
At an emergency meeting with several of Lindsay's top aides, Schaffer presented her findings. “Considering how serious this situation is," said Schaffer, "we think it's critical that testing for lead be made part of the standard medical checkup for every child in this city."
There wasn't even time for a reflective pause. “Given that we can't do anything about deteriorating housing stock," one official said, "it would be better not to."
The reaction of Mayor Ed Koch's administration to the crack-baby news was, for Schaffer, a horrific trip down memory lane. "After circulating my crack-baby report, says Schaffer, “I got a call from someone who said, ‘We hear you've written a report that says children of color are inferior.’" Other than this novel interpretation, official reaction was a resounding silence. When Schaffer finally
asked a senior Koch aide if there were any plans to publicize her findings, the answer was no.
“The numbers involved were overwhelming," says Schaffer. “I think the general feeling was, again, if we even admit there was a problem this big, we'd all drown. Better not to."
IF SET DOWN IN THE MIDST of a particularly bloody battle, Ira Chasnoff would doubtless later describe his experience in the friendliest possible manner -right down to the mangled corpses. Normal conventions that cloak tragedy - the knitted brow, the hushed voice - are absent from this Chicago neonatologist. While all doctors are trained to be matter-of-fact about death and disease, Chasnoff is positively zenlike. And it is this weirdly nonjudgmental stance - along with matinee-idol looks - that allowed Chasnoff to win the trust of so many of his city's pregnant addicts.
“Your baby's head circumference is below the fifth percentile” he'd inform an addict, with less agitation in his voice than others might have when speaking of a rainy day. And because the addicts understood that he'd never blame them or betray them, they let him study their babies. Chasnoff thus became one of the first scientists to warn that prenatal cocaine exposure warranted serious attention. His initial studies were the very ones that warned Judith Schaffer.
It was in the mid-Eighties that Chasnoff put the word out that any pregnant addict who was worried about her baby could come to his clinic. The deal was this: Chasnoff and his staff would provide free prenatal care if the women participated in outpatient drug treatment. More and more women showed up, and from this population, Chasnoff began collecting data - both on the women and the babies they bore.
The results were overwhelming. Strokes, small head circumferences (a sign of possible retardation), low birth weights and Apgar scores, a greatly increased risk of crib death -the list went on and on. And some scientists have since speculated that, as depressing as Chasnoff's findings are, they actually represent a best-case scenario.
To begin with, the women Chasnoff studied were addicted to cocaine, not crack. (For various reasons, crack has never caught on in Chicago.) While the chemistry of the drugs is, of course, the same, patterns of use are not. Chasnoff's women were far less likely to binge in the extravagant way a crack addict does. Though no one has been able to link dosage to damage, common sense suggests that more cocaine is probably worse than less. This is not to say, however, that there is such a thing as a "safe" dose of cocaine - at least for the baby.
In addition, most of Chasnoff’s patients were in their midtwenties, optimal childbearing time. Perhaps most important is the fact that by virtue of being in the program, they were getting prenatal care - a rarity for the vast majority of addicts.
Other doctors have since replicated many of Chasnoff's findings, as well as made some discoveries of their own. A number have found staggering miscarriage and stillbirth rates depending on which study you read, children of cocaine-abusing women stand as much as a sixty-percent chance of dying in utero or during the first year of life. In some cities, crack is the abortion method of choice for regular users in the first trimester. For women about to give birth, street wisdom has it that a first-class binge will get labor going. Maternity wards in major city hospitals are by now used to blitzed-out women having one-hour labors.
Perhaps the most chilling studies have come from Dr. Suzanne Dixon, a behavioral and neuro-developmental pediatrician at University of California, San Diego. Dixon looked at a group of crack babies who had abnormal ECHO (neurological ultrasound) results - of that group forty-one percent had serious intercranial lesions. In other words, they had holes in their brains.
THE LITTLE BOY SNEAKS over to a toy box and quickly stuffs two tiny plastic dolls in his pockets. His sister, who has been scribbling up and down her arms with a ballpoint pen, looks up. He begins to run, but she's too fast for him. She rams him hard, knocking him down, and begins clawing at his pockets. “Matt! Serena!" yells Annie as she pries apart the howling children.
Matt has recently developed an attachment to these dolls. This may not seem extraordinary behavior in a four-year-old, but in Matt’s case it is. "I'm grateful to those Ninja men," Annie says. "It's a real big step for Matt in terms of learning how to play like a normal kid. It's the first time he seems to realize that toys are fun things rather than weapons or part of an obstacle course. Even Serena seems to sense how important this is. And it drives her crazy. She's always trying to get the Ninja men away from him."
Matt now leans against his mother, fingering one of the Ninja dolls. Thwarted, Serena turns to the cat, who’s sleeping in a corner, and kicks it squarely in the head. Later, when her mother is distracted for a moment, Serena will slip away. In less than a minute, the two-year-old will start a fire in the kitchen.
Crack babies aren’t that fond of faces. Too much eye contact tends to overwhelm them.
CRACK BABIES ARE LIVING, breathing examples of what doctors call “soft" neurological damage. Soft in this context simply means it's difficult to put your finger on what's wrong with them. That is, it's difficult until they are compared with normal children.
Normal babies crave contact with other human beings. They love to be looked at, sung to and held. Their brains are only as sophisticated as that of an adult rat's -all those experiences of being looked at, sung to and held are what will stimulate their brains to forge connections and develop the sort of prefrontal cortex that will enable them to read Shakespeare some day. Their favorite sight is their mother's face. In fact some development specialists believe that the baby's capacity for all future learning depends on those first few weeks when mother and newborn gaze into each other's eyes as though each were discovering a new country.
Crack babies aren't all that fond of faces. We advise our parents not to make too much eye contact with their babies," says Ira Chasnoff. "It tends to overwhelm them." Actually, any human contact can overwhelm a crack baby. Chasnoff recommends bombarding these children with what he describes as "only one sensory modality at a time."
In other words, if you're holding the baby, be silent and look the other way. (An instruction video for parents of crack babies shows a solemn doctor holding a wary baby facing outward) If you're singing to your baby, put him in his crib, turn out the lights and keep your distance. Eye contact? Add light, maintain distance and hold the vocals.
Other "soft" signs: Crack babies stiffly arch their backs to escape whoever picks them up (normal babies automatically snuggle). They cry in a high feline wail, sometimes for hours on end, and nothing can console them. That creepy catlike cry is itself indicative of neurological damage. And during a crying jag, their rigid little arms flap about, which makes them even more frantic: They seem to believe their arms belong to someone else, a vicious someone who relentlessly flogs them. In short, these babies lack just about everything that makes adults coo.
Crack leaves nothing to chance. Not only does it make babies only a mother could love, it wipes out that love as well. When pregnant crack addicts are asked to draw a self-portrait, they never draw themselves pregnant. They turn away from ultrasound pictures with revulsion. Drug counselors now look back to the days of heroin families with something verging on nostalgia. Heroin mothers could still buy groceries, they still occasionally gave a kid a bath.
There's no such thing as a functioning crack family. Boarder babies are what you end up with when a man, a woman and crack get together. As for the children who aren't abandoned, child-abuse rates have more than tripled in some urban areas since crack came to town.
SERENA LIFTS HER SHIRT and points at her bellybutton. “Boo-boo,” she says and gives a deep laugh. “For some reason she thinks her bellybutton is the funniest thing in the world," says Annie. "It's the only thing that makes her laugh - other than causing someone pain." It's anyone's guess whether Serena would continue to find her bellybutton so funny were she ever to learn the enormity of the boo-boo that centers on it.
Serena tires of contemplating her navel. She runs to the cleaning closet, pulls out a broom and starts swinging. Lamps and books fly.
“The neurologist is telling me she's going to have to be medicated before I can even think about preschool," says Annie. “My feeling is, this child's had enough drugs. And if I’m honest with myself, I don't know if she'll ever even go to school. Serena needs to be in a class of one. Actually, what Serena really needs is to be on a farm - except she'd probably punch out a cow.”
THE FACT THAT ONE East Palo Alto, California, sixth grader recently beat up another didn't particularly faze Dr. Charlie Kelley Knight, superintendent of public schools there. “It happens," is her response. We deal with it. That the sixth grader happened to knock some of the other child's teeth out was also taken in stride by the superintendent "But when that child failed to show the slightest sign of remorse you tell me what's going on and what we're supposed to do," says Knight. “That's what my job has been like since cocaine began crippling our children.”
About three years ago, Knight called a meeting with some of her kindergarten teachers. She was worried by the fact that so many kids were showing up completely unprepared for first grade. The answer, she had decided, was to make kindergarten a more academic experience. Knight was prepared for some opposition from the teachers. She was not, however, prepared for mutiny.
“These kids aren't like the kids we used to have,” protested one teacher. “They're disoriented, they can't follow directions. They have no friends. They don't even seem to need us. And whatever we do to help them, they don't get better. One day they'll know their numbers and colors, the next day it's as though the slate were wiped clean. They can't even remember their potty training!"
Since that time, Knight has developed a program for drug-exposed infants and toddlers in the community. She is justifiably proud of her results there. But her pride evaporates when the talk turns to the older drug-exposed children.
“We've done nothing for them," Knight says. We don't have the money and even if we did, we don't know what should be done. A lot of them have already been kicked out of school- these children are violent. The public still hasn't grasped the fact that these sweet, developmentally delayed children aren't going to stay sweet and little and harmless. These are the kids who one line day bring guns to school"
Social workers and teachers tend to get angry with Charlie Knight They hate the way she uses the expression drug baby. ("They made me polish up the name for our intervention center," she says with a smile. It has this nice euphemistic name now - the word drug isn't even mentioned.") And they hate that she isn't at all optimistic about the future of these children. There are some folks who want to believe these kids will grow out of their problems, that early intervention means they'll be just about normal" says Knight. My response is, while early intervention certainly helps, they don't get better. They get worse."
“You can’t tell what makes these children happy or sad. They are like automatons.”
JUDY HOWARD IS THINKING about giving up the lecture circuit. The UCLA pediatric researcher is tired of being attacked for her radically pessimistic views on the long-term prognosis for crack babies.
"It's so sad," says Howard. Almost as soon as we were able to talk about what the bad news was, people didn't want to hear any more of it."
Howard, who has studied groups of crack children at UCLA's Division of Child Development, is known for her belief that cocaine attacks the pleasure pathways in the brain of a developing fetus. “They lack affect – you can't tell what makes these children happy or sad," she says. "Their faces are joyless. It's as though the part of the brain that makes us get a kick out of life has been wiped out. They're like automatons."
Not surprisingly, Howard is repeatedly slammed by the early interventionists and those who've adopted crack babies. Even parents whose children have been in Howard's early intervention program have later rejected the doctor's conclusions. One little boy, who soon after his first birthday was breaking windows and strangling the family cat, spent some time under Howard's care. The violence abated somewhat, and the parents decided he was cured. Against Howard's advice, they pulled him out of the program. Recently, Howard got a call from the mother, who asked the doctor to recommend a place to have her son's hearing tested.
“Why?" asked Howard. “Well, he can't follow direction in school and he has no friends," said the mother. Testing proved the child’s hearing perfectly normal.
"The parents chose to interpret his social difficulties as the result of a hearing loss instead of brain damage," says Howard. "Denial is rampant in this field - even with my adoptive parents who admit there's a problem. Their form of denial is that they want to keep their child's problems a secret."
Howard has repeatedly pleaded with her adoptive parents to go on TV to help spread the word. None will do it. "They're protective of their children, and I sympathize with that," she says. "But what I want to know is, who's going to lobby for these children? The parents of my cerebral palsy kids and Down's syndrome kids have always been out there. What's going to happen to crack babies if the people who love them won't go public?
“It is difficult to talk about these children to outsiders," Howard says. In many ways the children look just fine. Especially if you structure their environment, if you organize every aspect of it for them. You can sit on these children to get them to play blocks, you can even work at getting them to smile. Those are the successes that the early intervention people are talking about. What they don't understand is that in order to function in this world, you have to be able to organize yourself."
Organizational ability is a dreary way to describe what makes us read the paper over breakfast, select a birthday gift, sing in the shower or hurl our arms around a long-absent friend, but this is child-development-speak. A more evocative demonstration of the importance of organizational ability can be found in videotapes Howard has made of three different eighteen-month-olds at play.
The experiment compares crack children with controls from two groups of children crack babies are often likened to - children with unstable, sometimes abusive home environments and premature babies. Each child was put in a room with a large variety of toys and left to play. In one sequence, the preemie heads straight for the dolls and enacts a bedtime scene in which he tucks the dolls into bed and kisses them good night. The child with an erratic home life is more interested in toy sized eating utensils; she soon sets up a full-fledged tea party. The cocaine child goes to the pile of toys and pulls out a spoon. Then he hurls it down. Same with a doll, a block, a truck, a ball. He seems engaged in a game of hot potato.
What's wrong with this last picture? According to Howard, the cocaine child doesn't play thematically. At every step of the way, an observer has a good idea of what the preemie and the child with the unstable background will do next. With the crack baby, there are no logical underpinnings to his play. It's as though he isn't capable of telling himself a story - an ability that isn't necessary for just the creative types of this world. Simply getting up each morning involves telling ourselves a story of what we hope the day will bring.
THE STORY ANNIE TELLS HERSELF IS EVIDENT in that after enduring more than a year of Matt’s medical problems, she still went out and adopted Serena. "While I sometimes question my sanity," she says, ”I never dreamed things could get this bad." After all, Matt was just emerging from the worst of his medical difficulties. Until that point, he simply hadn't been strong enough to misbehave. And doctors kept telling Annie how cute the little boy was, that she shouldn't worry so much, that everything would be fine in the end. Annie is a religious woman; she believes in the power of redemption, and she believed in the power of medicine. Adopting Serena was a way of proving her faith that one day Matt would be well.
A year later, Annie was learning sign language. Doctors were warning her that because of brain damage he'd sustained, her son might never learn to talk. A year after that she wrote in her diary: “I have never known such frustration, depression and fear. I have tried every kind of discipline. I have spoken to countless doctors and child-care experts. I always hear the same thing. ‘It's the drugs.’ ‘We can't do anything now.’ ‘We feel so sorry for you.’ ‘There is no cure.’ ‘Find a sitter and take some time for yourself.' Then there is the pat on the back for the good, unselfish job I'm doing."
“I'm keeping this diary,” says Annie, "so some day if they can read, they'll understand what was done to them and what they had to overcome."
THE DEBATE OVER WHAT HAPPENS TO crack babies when they grow up has been further muddied by the fact that a number of experts in the field have actually adopted some of these children. Optimism is only human under such circumstances. Dr. Xylina Bean, associate director of neonatology at Martin Luther King Hospital, in Watts, California, lectures all over the country on the dangers of crack during pregnancy. She is also the adoptive mother of an adorable little girl who was exposed to crack prenatally. And Bean makes no bones about her agenda.
"There's no question in my mind that with every hit, the pregnant woman is playing Russian roulette with her baby's brain," Bean says. “But we still don't know exactly what that damage is going to be. My daughter is fine so far. I get calls all the time from folks trying to decide if they should adopt a crack baby. I just tell them God doesn't give any guarantees and that I’m a firm believer in the power of the environment.
"Sure there may be serious behavior problems," she adds. “I worry though that publicizing everything that's negative about these children will make it less likely that people will adopt them. My goal is to get everyone who's ready to be a parent to adopt one of these kids. Then maybe we'd make a dent in the crack-baby problem."
You'll never hear the expression “drug baby" or "crack baby" at the Salvin School, a special-needs public school in Los Angeles - despite the fact that it is home to a pilot program for children who were exposed to drugs in utero. Perhaps even more than Xylina Bean, Salvin teachers worry about the stigma of labels. Like Bean, they are passionate advocates for their children, and they have infinite faith in the rewards of hard work.
On a bright and windy Thursday at the Salvin School, red lollipops are handed out as a special treat during morning assembly. Afterward, back in the classroom for the drug-exposed preschoolers, five-year-old Simon is in hysterics. One teacher allowed her students to start sucking their lollipops right away. But Simon's teacher has told her students to wait till after lunch.
“It got all mixed up, didn't it, Simon?" his teacher, Carol Cole, says gently as she pulls him into her lap. The child nods tearfully and eventually quiets down. Cole parks him in a chair and proceeds to read a story to her group of six children. In the time it takes to read a ten-page picture book Simon will rise from his chair more than thirty times. Whatever is depicted -school bus, caterpillar or house – Simon’s response is to jump up, run to Cole and hit the page, shouting, That's mine!"
In a soft, firm voice, Cole keeps reminding him to take his seat. The other children wriggle ceaselessly in their seats as well. From time to time they join him in running up to the book.
The Salvin program is a success story from the crack-baby front. Two of its graduates were recently accepted into regular kindergarten. Another child who used to have hour-long temper tantrums has been partially mainstreamed. Many of the current batch of children seem to understand that toys are for playing. Many have no problem holding eye contact or bestowing a smile. Some have even learned standard preschool skills, though Cole admits that one day they may remember how to tie their shoes or what a puzzle is for, the next day they may not.
Whatever is learned here, the Salvin School is not - at least in the world of crack babies - a depressing place. To the uninitiated, this just looks like a classroom of hyperactive children who happen to have an enviable student-teacher ratio.
And therein probably lies the reason for much of the success of this program. There is one teacher and one teacher's aide per six children. In addition, there's a psychologist, a social worker, a speech therapist and a pediatrician on site. It costs more than $15,000 a year to keep a child in Salvin for three hours a day, five days a week.
Complementing the staff-intensive approach is an exclusive admittance policy. Salvin accepts only the least damaged of the drug exposed. “We don't take children who are mentally impaired or who have serious medical difficulties” a teacher says. We also prefer children without history of abuse, who live in a somewhat stable placement." Despite the river of love that washes over Annie's children, neither Matt nor Serena would likely be considered for a program like Salvin. There both simply too wild.
Salvin teachers are bullishly optimistic about what these kids can do if given half a chance. “We believe it's hard to say what makes these children the way they are,” says Carol Cole. Most of our children are in foster care. A lot of their behaviors could just as easily stem from having a chaotic home environment as from exposure to drugs. We're very worried that all this talk of drug babies means they're going to be stigmatized as hopelessly handicapped for life.”
WHAT'S ESPECIALLY APPEALING ABOUT those who argue nurture over nature is that in their world, nothing is forever -anything that's abnormal about these children can be coaxed out of them. At least in theory it can. Unfortunately, people don't live in the realm of theory. Here are some basic activities that Annie, who has striven mightily to effect change through a good home life, still can't do because of her children's handicaps:
Have a paying job. In fact, Annie has had to go on welfare because the kids are too wild for day care. Only Matt has qualified for an early intervention program.
Sleep through the night. One night Matt stopped breathing fourteen times in the space of forty-five minutes. When he was little, Annie had to sleep with a hand on his chest. And today, Serena won't go to bed till one or two in the morning. Even then, it's generally only an hour or so later that she wakes and slips out of her crib. Annie has the crib pulled up smack against her own bed so can feel when the child starts to shimmy over the edge. "It's like living with Tinkerbell," says Annie. “Tinker-bell with a mean streak"
Read, watch TV, talk on the phone, knit or laugh. As soon as Serena notices her mother engaged in a pleasurable activity, she does her best to stop it. As these efforts involve wielding a variety of household objects (the child already can heft ten pounds), Serena generally succeeds. When Annie laughs at a joke a visitor tells her, Serena’s response is to run over and slap a hand over her mother's mouth.
Live without elaborate bars and locks. Because of Serena's constant and surprisingly sophisticated quest to escape, their house resembles a fortress. Annie recently found Serena standing on top of a chair she'd pulled to the front door, avidly working a key in the top lock.
Take the children on the subway-at least without causing a ruckus. The last time Annie tried, Matt hurled himself onto the platform and began shrieking when his mother wouldn't let him get on the wrong train. "I'm guaranteed at least one episode that embarrasses me to the roots of my hair," says Annie.
Take them to McDonald's. “Unless its a drive-through," Annie says. "Isn't that sad? Imagine being the sort of person no one wants to take to McDonald's."
IF EVERY YEAR 375,000 WHITE MIDDLE class children lost a limb because of the actions of a strange and implacable cult, national outrage would know no bounds. But given the fact that crack is perceived as a minority problem (though plenty of whites are addicts), and given the fact that this society has never leapt at the chance to spend real money on poor children in need, it's perhaps understandable that the response to 375,000 babies being crippled by crack each year has been so casual.
Virtually nothing has been done at the prevention level. There isn't even the whisper of a coordinated education effort aimed at teenagers. As for help for the already addicted, New York City, for instance, has about thirty beds -all filled- in drug-treatment facilities for pregnant addicts who somehow muster the courage to ask for help. For the many, many others whose courage isn't of such heroic proportions, well, there's always that useful word no.
Only a handful of schools and charitable organizations have started programs to deal with a select few of these developmentally crippled children. And the few doctors trying to figure out exactly what is wrong with these children are in constant danger of having their funding pulled. Given such public indifference, it's no wonder child advocates are despairing. After all, twenty years have passed since lead was acknowledged as a threat, and ghetto children continue to be poisoned in the privacy of their own paint-peeling homes.
What little national outrage over the crack-baby crisis that does exist has been channeled into the dubious solution of expanding child-abuse laws to include use of illegal drugs during pregnancy. To date, eleven states have enacted such amendments and more than fifty women have been prosecuted. It remains to be seen how this approach is going to transform the lives of crack-addicted mothers. Meanwhile, almost a third of some city maternity wards continue to be occupied by crack babies. Some studies estimate that within a few years, up to sixty percent of school-age children nationwide will have been prenatally exposed to drugs. And Annie, Matt and Serena continue to wait for the light.
SERENA STANDS ON TOP OF THE COFFEE table. "Help," she says in a low, flat voice. "Help." She free falls forward, arms outstretched, and gets a nasty bump right in the middle of her forehead. Annie runs to her, but the toddler seems oblivious to pain. There's a commotion by the front door. Matt has just been dropped off from his early intervention class. Her wound still red and raw, Serena rushes to the door. Before Annie opens it, she looks down at the tiny child by her side. “Are you going to play nicely with your brother or are you going to be bad and fight?"
The child smirks, then growls: "Fight."
Serena keeps her word. Within minutes she and Matt are embroiled in one-on-one combat, rolling over each other, howling with inchoate rage. For perhaps the 10,000th time, Annie peels them up off the floor, separates them and, with each arm, pulls her changeling children to her in a great smothering embrace.
“I love my kids, but if I had to do it over again, I wouldn't," says Annie. “I tell myself, ‘Someone's got to do it. But in my darkest hours, I wonder how much good I even can do. I give and I give and I give some more, and it's like Matt and Serena are a couple of glasses with holes in the bottom. I don't think all the love I'm pouring in is ever gonna come back to me."
She seldom writes in the diary anymore. Annie has a hard time telling herself any longer that the diary's original purpose - to chronicle her children's triumph over adversity - is going to be realized. And looking back at her first hopeful entries is just too painful. This is what she wrote when she first adopted Serena: “Serena came to me January 22nd, 1988 at age twenty-seven days. She weighed five pounds. So pale her veins showed through. This hairless fragile thing. Ears like little flowers that have yet to open. I am told she is the product of a drug-abuser mother - cocaine, heroin, alcohol, barbiturates. That's all I know for now. I can't believe I finally have my daughter. Sixteen years I have waited. She is newborn, fresh from the hospital and I got to NAME HER! I couldn't ask for more."
The names of Annie and the drug-exposed children mentioned in this article are pseudonyms.