Neurologic manifestations of cocaine exposure in 19 (46%) of 41 children, ages 2 months to 18 years, found to have cocaine-positive urine screening tests during a 1-year period (Jan - Dec 1990), are reported from the Children’s National Medical Center, Washington, DC. Seizures were the most common symptom of neurotoxicity, occurring in 7 children in the age range 1-8 years. Obtundation occurred in 6 (ages 5 mos-18 yrs); delirium in 4 (ages 16-19 yrs); dizziness 1 and drooling 2 (ages 16-18 yrs). Seizure patterns were focal with secondary generalization in 3, generalized in 4, and were associated with fever in 2. Passive intoxication in a closet where “crack” was smoked was the most likely cause of exposure in young children. An additional 14 adolescent patients with positive urine screens had neurologic complications of head injuries, and cocaine-related symptoms could not be evaluated. [1]

COMMENT. Seizures were the commonest manifestation of cocaine exposure and neurotoxicity in young children. Adolescents suffered from alterations in mental status. Urine screen for possible cocaine exposure is recommended in children with first-time seizures, afebrile or febrile.

A study of the relationship between maternal cocaine dependency and child maltreatment at Yale University School of Medicine showed that 47 infants cocaine-exposed in utero were at increased risk of maltreatment (physical abuse, sexual abuse, or neglect), and placement either in foster care or with a substitute caretaker during the first 24 months of life. [2]

The nonspecific nature of symptoms of cocaine poisoning in infants is stressed in a case-report from Duke University School of Medicine. A 5-month-old male presented with lethargy, unresponsiveness, vomiting, and diarrhea. A urine screen was positive for benzoylecgonine, a cocaine metabolite. [3]

An evaluation of the 3-year behavioral and developmental outcome of 93 children exposed prenatally to cocaine and other drugs taken by the mother during pregnancy is reported from the National Association for Perinatal Addiction Research and Education, Chicago, IL. Cocaine exposure predicted poor verbal reasoning on the Stanford Binet. Marijuana exposure predicted poor abstract/visual reasoning [4]. Women who use cocaine during pregnancy also use more tobacco, alcohol, and marijuana than non-cocaine users. When these differences between exposure groups were controlled, there was no significant effect of prenatal cocaine use on infant growth and morphology. [5]