Baby alarm

How agencies are facing up to the growing problems of adopted children born to drug abusers

Airedale hospital in Keighley, West Yorkshire, is a small district general hospital in a part of the country not known for social deprivation. Yet on its maternity ward, some 20 babies a year are born addicted to opiates. "We have seen an increase year on year," says consultant paediatrician Kate Ward, who works on the neonatal unit. "In Bradford, you could probably multiply that number by 10 - and the same would be true of any big city."

Not all drug users are bad parents, Ward stresses. "Plenty hold down a job, lead stable lives and do not involve their child at all in their drug-taking," she says. "But if things fall apart, you can end up with the child being physically, sexually and emotionally abused. I've even seen cases where children have been injected with drugs. The most important thing is the wellbeing of the child."

Inevitably, many babies and children are taken away from drug-using parents to be either fostered or adopted. Occasionally, care proceedings may start as soon as the child is born. In other cases, things go well initially but, after a few months and despite the best efforts of everyone involved, the drug abuse starts again, other problems kick in, and the baby is taken into care.

Ciaran Rafferty, family placement service manager with Manchester social services, says: "Drugs are a very significant feature in Manchester and other comparable cities and we have seen an increase in the number of babies and young children being placed for adoption. We have no problem placing them - the younger the child, the easier it is."

While local authorities do not keep figures on the specific reasons for children being taken into care - usually there are multiple, complex factors - anecdotal evidence indi cates that parental drug abuse is becoming a key issue. "What a number of social work departments are seeing is that, when young children end up being taken into care, some sort of drug abuse is featuring far more often," says Marjorie Morrison, child placement consultant in Scotland with the British Agencies for Adoption and Fostering (Baaf).

In addition to the chaotic, risky and often criminal lifestyles that accompany drug dependency, many young women are incapable of responding normally to their babies. "Many of them are flat emotionally," says Morrison. "They may not be clinically depressed, but they do have a more depressed approach to life - and that has implications for how they respond to their child and what they can offer the child."

Babies may be disadvantaged from day one. Where they have been exposed to opiates while in the womb, they may suffer what is called "neonatal abstinence syndrome" (Nas) after birth. "The baby cries for feeds, but doesn't feed well, has diarrhoea and snuffliness," says Ward. "But it's the neurological symptoms that are the most difficult to deal with. Babies are jittery, irritable, have breathing problems and an abnormal, high-pitched cry; their temperature control is affected and they may even have convulsions."

Such babies usually recover fairly quickly, even if opiates have to be used in treatment. But the long-term effects are more uncertain. "Adoptive parents are very concerned that the baby may have been damaged in some way," says Ward. "Their second worry is whether the baby will grow up to be an addict. That's a question we can't really answer, though we do know that there are genetic aspects to addictive behaviour."

Some people feel that babies affected by Nas may, if anything, be more advanced developmentally. Sushila De Sousa, child placement consultant at the Leeds office of Baaf, says: "From my own observation, I would say that these babies are reaching their developmental milestones earlier than other babies coming to us. They are walking and talking earlier. Several experienced foster carers have noticed this with babies born to mothers addicted to heroin. I began to wonder whether this was due to the parents' drug use."

De Sousa, like some other workers in the field, fears that, as these babies get older, this tendency may manifest itself as hyperactivity. There is some evidence for this from research carried out in Israel. Children born to parents with heroin dependency and raised at home were found to be impaired in verbal, reading and arithmetic skills, while those who had been adopted had more or less normal intellectual and learning abilities. However, there was a high level of attention deficit hyperactivity disorder (ADHD) among all the children born to parents with heroin dependency - both those adopted and those brought up by birth parents.

This points to a long-term neurological effect of exposure to heroin before birth. But clearly a stable, stimulating and nurturing environment can make a difference to the outcome for a child affected by opiates before birth.

Amy was born to drug-abusing parents in West Yorkshire. The outlook for life with her teenage mother, who had herself been through the care system, was poor because of her severe drug problem, her lifestyle and her inability to engage with the baby. Amy had to be treated for Nas. She spent a week in hospital and, when she had recovered, she went to a foster carer. Her birth mother did not keep up contact, while her father developed mental health problems and contact with him was no longer considered advisable.

Amy was a small but alert and quick baby who crawled and started using words early on. Her foster carer, who was experienced with babies, was surprised by how active she was and how quickly she reached her developmental milestones. Amy went through a freeing order for adoption and, when she was 10 months, she was placed with a family that could offer her the stability and warmth she needed.

After initial difficulties, Amy settled within a few weeks. She continued to be an extremely active baby and toddler who needed to be watched constantly. Before her first birthday, she could scale the side of her playpen and throw herself over. Her adoptive parents, who had already adopted two other children, found Amy's behaviour unnerving.

Two years on, she is still very active and seems to have no fear. The adoptive parents have little time for their other two children because they have to concentrate on Amy, but the family is still together and determined to persevere.

Such determination is typical of those who adopt babies of drug users. "Babies are hard to come by and people are prepared to take the risk," says De Sousa. "At the moment, we just can't be categoric about the long-term effects.

"In the light of this, a number of agencies in this area are recognising that it may become necessary to pay an adoption allowance to the parents if the child develops problems at a later date. It is an acknowledgement that we don't know enough about the long-term effects of the drugs on these children."