Note: This article originally ran on June 4, 1989 as part of the AJC’s award-winning “Suffer the Children” series.
At Grady Memorial Hospital, a baby girl the size of a human hand lies in a glass bubble trying to stay alive. The baby's mother, a 22-year- old cocaine addict, shot up only hours before her birth, causing the placenta to rip free of the woman's body and sending the mother into a rapid, frantic labor. The baby was born seven weeks before she should have been.
Because of the cocaine in her veins, she was born in shock with a profoundly low heart rate. A plastic bag lies on her abdomen, collecting her waste directly from the hole left in her intestine.
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She still has periodic seizures from too little blood flow to her brain, making her a strong candidate for cerebral palsy and mental retardation. Her immature lungs require an oxygen hood, and her tiny body jerks to a rapid rhythm as she labors to breathe.
"This baby is going to be a disaster," said Dr. William R. Sexson, a neonatologist and medical director of Grady's special care nurseries. "She will never be a functioning member of society."
Babies like these are about to crush the state's already overwhelmed public hospital and child welfare systems. They are a new and sickly population of homeless children, left in the wake of skyrocketing cocaine abuse and the related specter of AIDS. At Grady alone, a staggering 200 babies a month are born who show signs of drug addiction, primarily to cocaine.
Increasingly across the country, these babies are being abandoned by parents to live as hospital "boarder babies."
"These are likely to be children forever in the care of the state," said Dr. Deborah A. Daro, director of research for the National Committee for Prevention of Child Abuse in Chicago. ''We are not finding a lot of homes that will take these children in."
Nationally, as many as 375,000 babies - one in 10 - are born each year to drug-or alcohol-abusing parents, according to the committee.
Experts say that not only are babies abused before they're born by pregnant women on drugs, they are also more likely to be abused after they're born if they're sent home with drug-using parents.
Heavy users of cocaine and its highly addictive derivative, crack, are incapable of caring about much else, including the welfare of a child. In one recent case, a Stamford, Conn., woman arranged on several occasions for her 10-year-old daughter to be raped by a 48-year-old man in exchange for money to buy crack.
Besides fostering neglect, crack has unleashed a disturbing wave of violence against children, child abuse experts say. In New York City, 11 percent of child abuse and neglect deaths in 1985 were tied to parents' drug use. By 1987, as crack use became widespread, that figure had jumped to 73 percent.
Murder 'Much More Likely'
Cocaine babies are more likely to be premature, suffer from neurological disorders, have cardiac malformations and experience respiratory difficulties. At Grady, 10 percent of the cocaine babies born prematurely become blind; 40 percent have the equivalent of a stroke, said Dr. Sexson. Many will develop dyslexia.
Such problems are stressful enough for a normally resourceful parent; they're overwhelming for one damaged by drugs.
"The drug babies are much more likely to be murdered because they're harder to manage and the families are much less manageable," said Dr. Michael Durfee, a Los Angeles child psychiatrist and national expert on child abuse homicides.
Phyllis W. Miller, Grady's chief pediatric social worker, said that in 1979, the hospital referred one baby of an addicted mother to child protective services workers; last year, the number was 212.
Increasingly, child abuse experts are recognizing that parents' drug addiction, particularly to cocaine, crack or PCP, could be a prescription for violent abuse or neglect of their children.
Yet Georgia has no policy linking drugs and abuse, and the state child welfare department has no requirement that hospitals report babies born to drug-abusing parents, although Grady does so.
"Maybe the state just needs to make a policy about children who are born addicted that says we consider this abuse or neglect," said Gerald V. Gouge, chief of the Child Protective Services Unit for the state Division of Family and Children Services in the Department of Human Resources.
Georgia is not alone in its lack of a policy. Only a few states, including Oklahoma and Utah, have laws requiring that parental drug abuse at least trigger an investigation by child protective services to determine whether a child is safe at home.
Besides the risk of abuse and neglect, babies born to drug-abusing mothers are also at risk of contracting the virus that causes AIDS. Georgia now ranks 11th nationally in its number of AIDS-infected children, according to the Department of Human Resources.
A study sponsored by the national Centers for Disease Control, due for release at this week's international AIDS conference in Montreal, shows that 1.8 of every 1,000 babies born in Georgia are now testing positive to the AIDS virus.
The majority are born to drug-addicted parents whose needle sharing led to their own AIDS infection, said Dr. Joseph A. Wilber, medical director of the AIDS programs for the Department of Human Resources.
Georgia was one of about 20 states that participated in the CDC study by testing all babies born between September of last year through February of this year. The study's results mean that this year alone, about 184 babies will be born in Georgia who test positive. Roughly a third will probably die from AIDS within two years, said Dr. Wilber.
National estimates are that by 1991, at least 20,000 children will be infected by the AIDS virus.
The implications are huge for a state welfare system that is already overwhelmed. Without a plan for the future, experts say drug-damaged and AIDS-infected babies will live out their lives in overtaxed public hospitals that are already straining under the weight of other medical and social problems.
These children's futures will be as grim as Dr. Sexson's 3-week-old patient at Grady. In her sterilized, incubated world, even the little white bear propped next to her head must be wrapped in plastic to protect her from germs. There is a tube through her belly and another needle in her hand. Yet, as fragile as she appears, this baby will probably live. "Most do," Dr. Sexson says. And like most, she'll probably go home.
After she was born, her mother promised the hospital social worker that she was going to get off drugs. "Both the mother and father are already shooting up again," Dr. Sexson said.
'He's Like a Stroke Patient'
On a window in Grady's intensive care nursery is a drawing of a child holding a bunch of flowers. "I have AIDS, please hug me," the poster says.
It's a sign of how things have changed since Dr. Barbara Bruner first began bustling down Grady's hallways 30 years ago, tending to sick children. In those days, there were no babies dying of AIDS. Babies born addicted to drugs were rare. And while children were beaten, burned and occasionally raped by their parents, they were considered the exception.
Last year, the hospital treated about 1,200 abused or neglected children, double the number the hospital saw five years ago.
"And it's not going to get better," Dr. Bruner, the director of Grady's pediatric emergency clinic, recently warned the state Board of Human Resources. "It's going to get worse."
On the ninth floor, a 14-month-old baby boy has been living in a steel crib. Dressed one recent day in a diaper and striped T-shirt, he lay alone in a room surrounded by empty cribs.
Three months ago, he was brought into the emergency room in convulsions. His mother had allegedly beaten him to the point of fracturing his skull, and the baby had to be whisked into emergency surgery to evacuate the blood clots caused by his brain hemorrhage.
"He's like a stroke patient," Dr. Bruner said as she petted the curly-headed boy's stomach. "He's paralyzed on his left side and he's got very stiff extremities. Plus he's brain-damaged. I think he doesn't see."
His future is unclear. Criminal charges are pending against his mother, but there were no witnesses to the beating, making a conviction unlikely. And she wants her child back. The county Department of Family and Children Services does not want to return the baby to a mother social workers consider unfit, yet they have had difficulty finding a foster family willing to take him just temporarily. Recently they found one.
A Hospital for a Home
Child welfare workers know a good thing when they see it. Too often, Grady officials say, the county drags its feet in placing babies such as these, knowing they are at least safe in the hospital. It is a trend Dr. Bruner finds increasingly frustrating.
Recently a baby with no medical problems lived at Grady more than a month after she was born. Her mother was psychotic and alternated between sleeping under a viaduct near the hospital and in Grady's lobby.
Finally, Dr. Bruner instructed her staff to call the Fulton County Department of Family and Children Services and tell officials the hospital was setting up a small bassinet under the viaduct so the mother could take the child home.
"Maybe that will be an incentive to do something about this child," she said. "The point is, we're stuck with the child. We have no legal responsibility for the child, except that we have no place that we would personally dismiss it to."
As many as eight babies and children live at Grady at any one time because there is no other place for them. Twice that number remain in the hospital for medical treatment with no contact by their parents, and the number will continue to grow as long as crack and cocaine remain a problem, experts say.
With cocaine, the greatest threat to unborn babies is prematurity, says Dr. Sexson, which creates a host of medical problems. Yet sophisticated technology has rendered survival of the fittest a thing of the past, and today many of these babies are kept alive.
"When I was a medical student, we didn't even fill out birth certificates on babies that weighed under 1,000 grams [2.2 pounds]," Dr. Bruner said, leaning over an incubator where a baby that looked more like a fetus lay with needles and tubes in her abdomen, arms, feet and mouth. "They were abortions."
The costs to society of keeping these children alive are enormous: $2,500 a day in a private Georgia hospital for a baby on a ventilator, $1,200 for care at Grady's intensive care nursery, and future unknown costs for a growing number of babies whose disabilities will be permanent.
Foster Homes in Short Supply
For one baby girl who was recently born at Grady with AIDS, the only person who offered to give her a home was a single man who also had AIDS. But his doctor wouldn't let him do it, arguing the baby's illness might complicate his own.
When the baby was 9 months old, her mother - a drug addict - came to the hospital and took her home. But a few days later, family members returned her to the hospital's emergency room. At 10 months, the baby girl died alone at Grady.
Such stories prompted Douglas G. Greenwell, director of the state Division of Family and Children Services, to recently blanket the state with an appeal for more foster parents willing to take AIDS babies.
The lack of foster families for such babies has forced some caseworkers to return children to what they know are dangerous situations, Dr. Bruner said.
Her voice becomes particularly high-pitched as she talks about a baby who on this particular day was in intensive care struggling to survive second-degree burns he allegedly got at the hands of his mother.
He had been brought to Grady a month earlier with a broken leg when he was only a month old. The mother admitted she had broken her baby's leg. Considering that confession a sign of good faith, caseworkers with the Cobb County Department of Family and Children Services sent the baby home with her.
Because Grady staff continued to protest, the county agreed to do a home visit and provide follow-up services. Almost four weeks to the day, the baby was br ought back to Grady, this time with severe burns to his legs, spine and scrotum. He had been dipped in scalding water.
The county has since filed for custody of both the baby and his 2- year-old sibling, and criminal charges have been filed against the woman.
"You don't burn a baby like that by accident," said Dr. Bruner. "And we don't send children home expecting them to die. We send them home expecting them to live."
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