Cocaine Exposure Doesn't Harm Infants, Study Says

These children are no more likely to have significant behavioral problems in their first three years than youngsters whose mothers did not use cocaine during pregnancy, University of Florida researchers reported May 16 at the joint meeting of the Pediatric Academic Societies and the American Academy of Pediatrics in Boston.

"We didn't find any support at all for the terrible things people had predicted would happen to these cocaine-exposed children, like very small, screaming, sick babies that turned into children who had many behavioral problems," said Fonda Davis Eyler, a developmental psychologist and professor of pediatrics at UF's College of Medicine. She is one of two primary UF scientists involved in the study, supported by a $3 million National Institute on Drug Abuse grant.

"We're not negating that people were seeing children exposed to cocaine who had serious problems. What we're saying is that their problems do not appear to be driven by prenatal cocaine exposure and instead could be related to other things that are going on with them," Eyler said.

As easy access to cocaine swelled in the 1980s, so did dire predictions that children exposed to the toxic drug in the womb would be brain damaged and irredeemable, despite little scientific evidence proving it. Each year, 45,000 infants are born who were exposed to cocaine in utero, according to the National Institute on Drug Abuse.

General behavior and temperament also did not differ significantly between cocaine-exposed children and their drug-free counterparts. But both groups -- who were largely from poor, uneducated families -- showed more behavioral problems than the national average, the study found. The researchers speculate that poverty and the children's home environment could be to blame.

The UF study also showed that traits seen in infants may help predict which children will be prone to behavioral problems down the road.

Scientific research is increasingly showing only subtle differences between children exposed to cocaine before birth and those who were not. But the studies and their findings are relatively recent, and the long-term effects of those differences are not yet known.

The UF scientists are quick to point out that assessments of behavior are just one of a host of growth and developmental issues that still must be explored.

"Just because there are no differences in behavior doesn't mean there might not be differences in other areas, such as language development or problem-solving abilities," said co-researcher Dr. Marylou Behnke, a neonatologist and professor of pediatrics. "We're delighted these kids haven't shown any major differences, but they're still pretty young."

The UF researchers evaluated more than 300 children from infancy to age 3. Half were exposed prenatally to cocaine, primarily crack. The children's mothers, who ranged from 18 to 43 years old when the study began, had similar racial and socioeconomic backgrounds. The women, who gave detailed drug histories, were tested randomly for cocaine use.

The study is one of the few to examine women who used rural public health clinics for prenatal care, while others have largely tracked women from drug treatment centers in urban areas.

Parents and primary caregivers answered hundreds of questions on three standardized tests that assessed the behavior and temperament of their children at five specific ages. The questions included whether the child daydreamed, was disobedient, got into more trouble than others the same age, failed to finish things, was destructive, had problems eating, fought constantly, pouted or sulked or was easily frustrated.

Overall, researchers discovered the questionnaires did not uncover significant differences in behavior or temperament between the two groups. Interestingly, the study did show the children's behavior at birth and 1 month was related to later temperament, conduct and learning problems, impulsivity and hyperactivity.

While parents or primary caregivers are considered to be the best judges of children's behavior, there's a chance their assessments may be biased, either exaggerating or underplaying problems, the researchers said.

UF researchers hope their findings help debunk the myths about children exposed prenatally to cocaine, which they fear could become a self-fulfilling prophecy.

"Our worry is that when you give children such negative labels, that if they don't do well, people will say they can't do better, and they won't be pushed or nurtured or helped, and other causes of the problems will be overlooked," Eyler said. "People will assume the cause of the problems is the cocaine exposure and that there's nothing we can do about it."

Barry Lester, a professor of pediatrics, psychiatry and human behavior at Brown University in Rhode Island who also is studying prenatal cocaine exposure, said UF's results are new and exciting. Lester said he is particularly intrigued by the added findings that infant behavior may help predict which youngsters are headed toward problems later in childhood.

"This means we may now have the potential for identifying which kids may have problems down the road so we can intervene early to prevent them," Lester said. "And if we can do that, it doesn't matter whether the kids were exposed to cocaine or not, the treatment would be the same."