Ever since the epidemic of cocaine and crack use that began in the 1980s, researchers and doctors have been concerned about the development of children born to women who used cocaine during their pregnancy.
Initially, research focused on the potential negative impacts of the drug itself, treating other factors associated with maternal drug use as interfering. However, as researchers accumulated more information, many concluded that focusing on the direct effect of the drug didn't provide a complete picture. In fact, in a letter to the editor of The New York Times on Nov. 28, 2003, 28 leading researchers in the field questioned whether the widely reported "crack baby" syndrome even exists.
In contrast to the lack of evidence regarding the toxic nature of cocaine itself on the developing fetus, the negative effect of cocaine use on the quality of care parents provide to their young children has been consistently documented. Thus, we studied how the type of care provided to toddlers who experienced prenatal cocaine exposure affected their development.
We followed 83 cocaine-exposed and 63 non-exposed children and their caregivers from birth until the children turned 2. By that age, 49 of the cocaine-exposed children remained with their parents while 34 were cared for by other adults. About half of the 34 children in non-parental care were cared for by relatives (kin care) and the rest by unrelated individuals.
We found that prenatal drug exposure was not directly related to the children's developmental outcome at age 2. However, we found that children in non-parental care, especially those in the care of people who were not relatives, had better environments than those cared for by their parents and performed better in several developmental areas.
This improved performance existed despite the fact that these children experienced more problems at birth than the children who remained with their mothers, including prematurity, and were born to mothers who were heavier cocaine users.
These results suggest that many of the negative outcomes observed in children of cocaine users may result from the quality of caregiving during infancy rather than from the direct effects of the drug in utero.
If the environment is, in fact, more important in determining child developmental outcomes than prenatal cocaine exposure, then developmental problems could be prevented and treated more easily. For instance, support could be provided either through direct intervention with children, by supporting women in their recovery from substance abuse, and/or in helping mothers improve their parenting skills. Finally, our study suggests that "kin" caregivers of cocaine-exposed infants and toddlers may also need support and help with parenting.