• There is a greater risk of prematurity and of problems with delivery (especially something called placental abruption, where the placenta separates from the uterus while the baby is still inside--a very dangerous condition). Once born, there is a greater risk of crib death.


• Cocaine interferes with growth in the womb, resulting in babies who weigh less, are shorter, and have smaller heads. Cigarettes and marijuana also have this effect, to a lesser degree. (See Dangers in the Womb.)


• Cocaine increases the risk of many different birth defects, although not dramatically. Most cocaine-exposed babies are born physically healthy. In some infants, however, the drug injures the brain in ways that can be seen on ultrasound scans and that might result in later behavioral and learning problems.


• Cocaine-exposed babies usually don't have the same awful withdrawal symptoms that babies exposed to heroin or other opiate drugs do. But they often are irritable or overly sleepy. They may overreact to noises or lights, or may hardly react at all. They may eat without stopping, or have difficulty feeding. Because they don't gaze at their parents' faces the way other babies do, parents often feel that their babies don't love them. This can make a parent who is already feeling guilty about using cocaine feel even worse.


• Many of these babies have difficulty focusing their attention or screening out distractions. Some have coordination problems. Many have difficulty controlling their behavior; they often act impulsively. However, it's not clear how many of these problems are due to the cocaine itself, since many nonexposed children have similar problems.


• Some cocaine-exposed babies grow into children with behavior and learning problems, but not all do. Other factors--most important, how well the child was raised--may be more critical than the fact of cocaine exposure in determining a child's outcome. This is really a key point: Just because a baby has been exposed to cocaine does not mean that he can't do well. However, he may need special help in order to overcome some of the problems caused by the cocaine.


• Many of the most severe behavioral problems are due not to the cocaine itself, but to the often terrible conditions the children grow up in. Many are neglected or abused, or exposed to domestic violence. A child exposed to cocaine might suffer psychological damage as his mother comes and goes, controlled by her addiction. Poor nutrition, lead poisoning, and inconsistent medical care often compound the problems. Help for these problems can make a huge difference in the lives of children, whether or not they were exposed to crack or other drugs before birth.

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