Yet we should not overlook the harm that may be caused by problems outside school, problems that may or may not be related to societal factors. In almost every school, regardless of students' race and class, teachers can identify children who underachieve because of problems beyond school walls. These children may feel that nobody cares about them. Uri Bronfenbrenner (1989) states that every child needs to have an adult who is "crazy" about them in order to develop intellectually, emotionally, socially, and morally:
Having a nurturing home is an essential resource for children; having a nurturing network of parents, relatives, and peers is even better; having a personal network and a society that is "crazy" about and supportive of children is best of all. Without this support, children become at risk. Specifically, neonatal conditions, quality of health, family characteristics, peer influences, community climate and resources, and social status are influenced by support networks and affect students' readiness to learn. Institutional and grassroots strategies that strengthen support networks, increase resources, and bolster the status of children may enhance their ability to take advantage of educational opportunities.
Low birth weight. Very low birth weight is sometimes an indicator of developmental problems. Of the approximately 45,000 newborns with very low birth weights who are born annually, roughly 20-25 percent die in infancy (Volpe 1991, p. 276). Adverse neonatal outcomes such as low birth weight might be prevented by adequate nutrition, appropriate health care, and/or changes in mothers' lifestyle (e.g., drug use) during pregnancy.
Very low birth weight babies that survive the neonatal period sometimes suffer motor or cognitive deficits that lead to learning problems in school (McCormick, Gortmaker, and Sobol, 1990). Hack et al. (1991) find that very low birth weight children with subnormal head size at 8 months are at increased risk of poor cognitive function, lower academic achievement, and abnormal behavior at 8 years of age.
Drug exposure. The problems of cocaine-exposed children have been documented by researchers (e.g., Chasnoff et al., 1985) and sensationalized in the media as the crisis of "crack babies." Some cocaine-exposed children have severe mental and physical disabilities, while others show delays in language development or problems in concentrating:
New findings suggest that cocaine-exposure does not always lead to developmental problems -- most children exposed to cocaine test within the normal developmental range without the help of treatment (Viadero, 1992). Media reports that suggest infants exposed to cocaine are "doomed" overstate the problem and stigmatize these children -- even cocaine-exposed children who show signs of poor health and developmental delay may improve with the help of early intervention programs. However, these treatment programs can be expensive (Chasnoff, 1991; Phibbs, Bateman, and Schwartz, 1991).
How many children are born at risk due to drug exposure? No one knows for sure. While the media have focused on "crack babies," it is less well publicized that maternal use of other drugs (e.g., cigarettes, alcohol, prescription drugs, marijuana) may also harm fetal growth and development, resulting in academic, behavioral, and health problems (Bauchner 1989; Hingson et al., 1982; Jacobs, 1991; Kline, Stein, and Hutzler, 1987; Zuckerman et al., 1989). Some studies indicate that 375,000 newborns are exposed to illicit drugs in utero each year, but many more cases of drug exposure, including the use of alcohol and cigarettes, probably go undetected (Chasnoff, 1991, p. 1567).
Are infants from particular social backgrounds at higher risk for prenatal drug exposure? Again, no one knows for sure about the rates of drug use by expectant mothers. Research by Chasnoff, Landress, and Barrett (1990) suggests that the prevalence of drug use among pregnant whites may be underreported and similar to that of pregnant blacks. Over a 6-month period, a comparison of the urine samples of pregnant women in a Florida county revealed that the rate of drug use among white women (15.4 percent) was similar to that of black women (14.1 percent). Black women more frequently tested positive for cocaine use, while white women more frequently tested positive for marijuana. By law in Florida, all mothers known to have used alcohol or illicit drugs during pregnancy must be reported to health authorities, however, black women were reported at a rate 10 times higher than white women. Why the difference in reported rates? Chasnoff et al. conjecture that, among other reasons, physicians may be more reluctant to report drug use by white private patients than to report black public clinic patients. Also, differences in physicians' perceptions of the severity of cocaine versus marijuana use may explain reporting differences. Comparisons of drug use by race may be misleading. For example, in one study, once respondents were grouped into neighborhood clusters, the prevalence of crack use did not differ significantly for blacks, Latinos, and whites (Lillie-Blanton, Anthony, and Schuster, 1993).
Poverty and neonatal health. Poverty is significantly related to poor neonatal health. In a longitudinal study of newborns in an eight county area of California, Braveman et al. (1989) find that lack of insurance is associated with higher rates of adverse neonatal outcomes (including low birth weight) in uninsured black, Latino, and Asian infants relative to insured white newborns. The greater the poverty, the greater the risk -- homeless women are less likely than other low-income women to receive adequate prenatal care and more likely to deliver a baby of low birth weight (Chavkin et al. 1987). The observed problems of drug-exposed infants may be caused in part by factors associated with poverty (Linn et al., 1983; Mayes et al., 1992; Viadero, 1992). Earlier studies that found severe "crack" effects may not have adequately controlled for complicating factors associated with poverty (e.g., poor maternal nutrition) that pose a threat to many impoverished children and may contribute to the health problems of infants exposed to cocaine.