WHEN SMOKING AMOUNTS TO CHILD ABUSE

FIVE years ago, my mother discovered a sore in her mouth. When it didn't go
away in a couple weeks, she went to the doctor, and was told she had mouth
cancer. It was a shock -- to her, to all of us -- not least because she'd
never been a smoker.

Her specialist wasn't shocked, however. My mother was, as he described it,
``a secondhand smoker.'' For nearly a lifetime, she'd shared a house with
my father and his cigarettes. Sure, she had gotten wise 10 years ago and
refused to let my dad smoke inside. (And yes, it was a little sad and
slightly comical to see him puffing away in the snow and rain.) But the
first 40 years had done their damage.

It takes only a fraction of that time for secondhand smoke to permanently
harm a child's lungs. Kids are especially vulnerable because their
respiratory and other systems are less developed than those of adults. They
inhale more frequently and each breath brings in more toxic chemicals per
unit of body weight. A new study attributes half the cases of asthma,
chronic bronchitis and frequent wheezing in young children to secondhand
smoke.

Surprise! The more smoke a child is exposed to, the greater the chance of
illness. Kids in homes where adults smoke at least a pack a day are twice
as likely to have asthma, 2 1/2 times more likely to have chronic
bronchitis, and 2.7 times more likely to suffer three or more wheezing
episodes.

( The study, from the federal Agency for Health Care Policy and Research,
is available online at http://www.pediatrics.org/ ).

Losing Custody Over Smoking

Those kinds of statistics make for powerful weapons in child custody cases
where secondhand smoke is a major point of contention. The dangers of
environmental tobacco smoke (ETS) are increasingly cited in cases that
involve children with respiratory illnesses. And the militancy among
parents is supported by many physicians -- from former Surgeon General C.
Everett Koop on down -- who refer to smoking as a form of child abuse.

``Potential exposure to ETS should be one of many factors considered in
custody cases,'' writes Joseph R. DiFranza, a pediatrician at the
University of Massachusetts Medical Center who is widely regarded as an
expert on the subject, in the April 1996 issue of the journal Pediatrics.
``Continued household exposure to ETS for asthmatic children despite
physicians' advice to the contrary may constitute neglect or abuse.''

In that article, Dr. DiFranza said secondhand smoke in the United States
each year was responsible for as many as 2.2 million ear infections, 21,000
tonsillectomies, 190,000 episodes of pneumonia, 529,000 doctor visits for
asthma -- and more. Smoking, he concluded, should be banned wherever
children are present. He called for new laws and polices to give children
protection from the risks that adults knowingly assume.

Family court judges across the country appear to agree. A few examples:

In Sacramento, 1993: a smoking mother temporarily lost custody of her
8-year-old asthmatic daughter after evidence was presented showing physical
harm to the child.

In Fulton County, NY, 1994: a 12-year-old boy with a history of pulmonary
disorders was removed from his mother's custody and given to the father
because of secondhand smoke. ``We are at a point in time,'' the judge
ruled, ``a parent or guardian could be prosecuted successfully for
neglecting his or her child as a result of subjecting the infant to an
atmosphere contaminated with health-destructive tobacco smoke.''

In Connecticut, 1996: a judge took custody away from a mother after the
father contended that his asthmatic son was hospitalized as a result of the
mother's smoking. The court's condition for the mother's visitation rights
stated ``she shall not smoke nor allow anyone to smoke in the (child's)
presence.''

And last month, Kimberly Rollins of Newman, Calif., obtained a court order
from Stanislaus County Family Court saying that her 2-year-old daughter is
to remain in a smoke-free environment and therefore is never permitted to
visit her paternal grandparents in their home.

Stevie Marie, who was born prematurely, has a condition known as
broncho-pulmonary dysplasia which makes it difficult for her to breathe on
the best of days. She has been hospitalized twice for pneumonia, has taken
four different medications to control her asthma, and has had at least
eight documented ear infections. But, despite the pediatrician's statements
that smoking aggravates Stevie Marie's asthma, her father, according to
court papers, has repeatedly returned her smelling of cigarette smoke.

The thought that parents and grandparents could continue to so jeopardize a
baby's health makes me shudder. The smell of a lit cigarette -- even in the
open air -- turns my stomach. And yet, I have reservations above how much
we, as a society, can legislate. In our rush to criminalize tobacco use, I
worry about the dangers of turning the smoker into a criminal. I worry,
too, about disrupting parent-child relationships.

Risks Taken

And I'm reminded of something. A boy I once knew used to go to his dad's
every other weekend, and typically came ``home'' with a cold, a sinus
infection or another bout of asthma. His dad didn't smoke. But his house
was dirty: full of mold, dust and all the allergens that triggered the
boy's chronic problems.

Finally, the mother couldn't stand it any longer. She talked it over with
the boy's pediatrician, and they both decided it was more important for the
boy to see his father than be protected from dust mites and mold. In this
case, it wasn't life threatening -- though, he had already been
hospitalized twice for asthma and medicated for years.

In retrospect, the decision -- though frustrating -- was a good one.
Because at 16, this boy is relatively healthy, his asthma is under control,
and, yes, he has a great relationship with his dad.

What are your questions? Phone (408) 920-5663, e-mail to solo@cruzio.com,
fax to (408) 271-3786, or mail them to Kids' Health, the Mercury News, 750
Ridder Park Drive, San Jose, Calif. 95190.