By Melanie Fridl Ross
GAINESVILLE, Fla.---It's a debate that pits nature vs. nurture, and one University of Florida researchers hope a new study will soon settle: Are cocaine-exposed infants more likely to flourish or founder if their natural mothers lose custody?
Even under such extreme circumstances, biology appears to hold sway, UF neonatologists reported Sunday (5/3/98) at the joint annual meeting of the American Pediatric Society and the Society for Pediatric Research in New Orleans.
Six months after birth, babies who went to live with a relative or foster parent were significantly less likely to smile, reach, roll over or sit up compared with children who remained with their mothers, though their motor and neurological development still was considered within normal range. Furthermore, a related study showed many of these infants weighed less and were shorter.
The lesson to be learned? Foster or so-called "kinship" care may not be the universal answer for these children, says UF researcher Kathleen Wobie.
Wobie is not saying a child should be left in an abusive home or obvious signs of neglect should be ignored.
"I'm not talking about the extremes of women who abuse their children," said Wobie, associate director of research programs in neonatology at UF's College of Medicine. "This is that more questionable zone where one would say it's probably not good to live with an addictive parent; on the other hand, it may not be any better - or it could even be worse -- to be taken out of the relationship with that parent and put into some other kind of care-giving situation.
"I think we can all feel pretty confident saying that putting these kids in foster care creates other at-risk situations for these infants," she added. "It's not an answer that's necessarily going to give an outcome that's satisfying."
Exactly why children placed in foster or kinship care don't fare as well is not yet clear.
"I think personally it's pretty traumatic for a baby to lose its mother," Wobie said. "We don't know much about how a baby interacts with its mother while it's in the womb and what happens when all of a sudden she's gone...And when you change caregivers, you change feeding schedules, formulas and environmental readiness for a baby," she said.
In Florida, 773 substance-exposed children were sent to live with a relative under protective supervision in the fiscal year that ended June 30, the latest statistics available, while an additional 52 were placed in so-called "kinship care" with no protective supervision, said Wayne Wallace, management review specialist for child protective investigations in the Office of Family Safety and Preservation, part of the state Department of Children and Families.
Another 415 were placed in departmental custody or in foster care, while 326 remained in their own homes with their parents under protective supervision, he said.
In the UF study, researchers tracked 290 children for three years. Seeking to determine the home environment's role in the children's growth patterns, they statistically controlled for alcohol and cocaine use during pregnancy so their findings would reflect a more accurate picture of how these children were faring under their living arrangements.
The team divided them into three groups: those whose mothers were not cocaine users (145), those whose mothers used cocaine during pregnancy and retained custody (81) and those whose mothers used cocaine but ended up losing custody to foster or kinship care (64).
Researchers ruled out that the drug-exposed children who did not grow as well were sicker at birth, though they did detect higher drug use among mothers whose children were placed in foster or kinship care.
"Our findings suggest environment is playing more of a role because at birth the children were all equally healthy," said Dr. Indrani Sinha, a pediatric resident at UF.
In addition, the children who did not remain at home with their biological mothers were more likely to have spent at least some time there before being placed in foster care or sent to live with a relative, Sinha said. But it was the babies who were immediately placed in foster care after birth that were at greatest risk for lowered motor development, she said.
"We're talking about subtle effects, but there are differences between the groups of children we studied. How well you grow has a lot to do with overall health and well-being, so we're kind of intrigued by our findings," said Dr. Marylou Behnke, an associate professor of pediatrics at UF.
While state laws vary, Wobie said that nationwide, communities are struggling with how best to protect and meet the needs of these infants. Current criteria for those decisions are inconsistent and differ among communities. Infants who experience out-of-home care need extra monitoring from physicians and health-care professionals, she added.
"We are not trying to rewrite public policy; we're just saying that current policies may have created new problems for the very children we are trying to protect," Behnke said.
Child protection investigators seek to determine whether a child is adversely affected by exposure to a controlled substance during the mother's pregnancy or by the parents' continued and chronic use of a controlled substance that impairs their ability to look after the child's immediate needs, Wallace said.
"If [a mother is] strung out, cracked out and just not able to function, can't keep a house, can't keep the basic needs for a newborn, the Department of Children and Families has the statutory authority and obligation to make sure that child's needs are met," Wallace said. "More than likely, we will attempt to go find the grandma or the cousin or the aunt or a relative to look after that child while we continue to try to No. 1, find the mother, and No. 2, work with the mother to get her to a space where she gets off that stuff and can become a protective, functioning mother to that child. That is, in my opinion, the intent of our legislation. We don't put every single one of these kids in foster care."
UF researchers said the answers are not always clear-cut.
"Our research data was not designed to answer the question of why infants were removed," Wobie said. "In both groups of kids with positive drug screens at birth, some went home and some did not. Obviously, other information came into play regarding the decision to remove them from their mothers."
Relatives who take in substance-exposed babies are not necessarily prepared for their arrival, she said.
"These are not families that were necessarily prepared for another birth; it's not like an adoption where homes are scrutinized and parents eagerly await and positively anticipate the child," Wobie said. "There's a lot of emotional stress going on because of the mother's drug use, and oftentimes the caregiver already has a number of other children to take care of. They tend to be grandmothers or aunts who are older and sicker. They are good women; they've just got a lot of economic and social stress, and often do not get the additional financial and support services offered to official foster families."
Wobie, Sinha and Behnke collaborated with Fonda Davis Eyler, an associate professor of pediatrics and neonatology and biostatistician Cynthia Wilson Garvan.
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