By Tim Bonfield
The Cincinnati Enquirer

CRACK ABUSE

Figures reflect people who have participated in Impact, a Hamilton County substance abuse treatment program: • 1,288 crack abusers have been admitted to the program, second only to 2,710 admitted for alcoholism. • Only 27 of the crack users were known to be pregnant during treatment. • While alcohol exposure is known to cause more severe brain damage to a developing baby than crack cocaine, crack abusers are more likely than alcohol abusers to be homeless, unemployed, involved in prostitution or otherwise live in ways that would be hazardous to an infant. Source: Hamilton County Job and Family Services

Babies who were exposed to crack cocaine by their mothers' drug abuse during pregnancy tend to fare better, researchers say, if they are placed in long-term foster care or given up for adoption.

But don't expect a medical study about intelligence scores to reverse a legal system that has long supported keeping babies with their mothers as long as there's no threat to a child's physical safety.

The study, by researchers at Cleveland's Case Western Reserve University, reports that a stimulating, supportive home environment outweighs the brain damage that occurs from prenatal cocaine exposure. Details appear in today's issue of the Journal of the American Medical Association.

The study tracked 376 children from birth to age 4, using an assortment of performance and verbal IQ tests. All the children were born from September 1994 to June 1996. Half were exposed to cocaine, half were not.

"Comparisons indicated that cocaine-exposed children in foster or adoptive care lived in more stimulating home environments ... than those of cocaine-exposed children in biological maternal or relative care," said lead author Dr. Lynn Singer.

In fact, cocaine-exposed children in foster care and adoption situations showed similar IQ scores to nonexposed children even though such children had to be exposed to high amounts of cocaine for agencies to justify taking them away from their mothers.

To local child health experts, the findings weren't surprising. Many other studies also show that infant brains often are able to recover from oxygen loss, chemical exposures and other injuries - as long as they grow up in a stimulating environment, said Dr. Anna August, a neonatologist at Cincinnati Children's Hospital Medical Center.

"This is true for many preemies. The environment is more important than the insult itself," August said.

However, such findings appear to conflict with how the system copes with drug-exposed babies in Hamilton County, where experts say lack of proof of imminent danger counts for more than providing a stimulating environment.

On any given day in Hamilton County - where the vast majority of crack cocaine abuse occurs in Greater Cincinnati - more than 1,500 children are living in court-ordered custody arrangements, either with grandparents, other relatives or an unrelated foster family.

About 75 percent of those cases are related to substance abuse involving a birth parent, according to Hamilton County Job and Family Services, which runs the 241-KIDS hot line for child abuse and neglect. But the county does not track exactly how many children were taken from their mothers specifically because of crack cocaine abuse.

In Hamilton County, just being exposed to cocaine is not considered an abuse serious enough to automatically take a child away from a mother. Instead, cocaine exposures, detected by urine tests at the hospital or during doctor visits, amount to a "red flag" to trigger an investigation into the family situation.

"We know that crack addicts aren't good parents. But people can recover and change," said Colleen Gerwe, Hamilton County's children's services section chief.

So cases are handled one-by-one. For example, if the mother denies she has a drug problem but a home inspection finds no food in the refrigerator and just a mattress on the floor, the county will pursue taking custody. But if the mother is getting treatment, the home appears safe and there are other responsible adults around, the baby may go home.

Evidence of past drug abuse is less important than assessing whether a mother can safely parent the child in the future, Gerwe said. And safety is the key measure, not so much whether a family has enough books around to provide a stimulating learning environment.

But when crack-exposed babies are left with their mothers, they are more likely to suffer learning disabilities, the Cleveland researchers reported.

"Our findings underscore the beneficial effects of environmental intervention in the prevention of mental retardation for cocaine-exposed children," Singer said.

"Drug treatment and education for this population of pregnant women, along with intensive intervention for their offspring, are essential to help maximize the future well-being of these families."

E-mail tbonfield@enquirer.com