IN HEARTLAND, CHILDREN SUFFER CONSEQUENCES OF PARENTS' METH ADDICTION

Once a scourge only in scattered pockets of America, methamphetamine is now
fueling an epidemic that has branched out from the West through the
heartland states, into cities, suburbs and hamlets nationwide. At least 12
million Americans have tried meth, one of the most addictive of all illegal
drugs. This story is the first in a series.

OTTUMWA, Iowa -- Jittery babies, mistreated toddlers, strung-out mothers:
Cheryll Jones' pediatric nursing practice is far from what it was when she
started out 30 years ago -- long before methamphetamine invaded this
riverside Corn Belt town.

"If anybody told me my primary caseload would be kids exposed to illicit
drugs, I'd have said they were crazy," said Jones, who used to focus on
such problems as lead poisoning and cerebral palsy. Now she heads a local
task force helping the most helpless victims of the nation's meth epidemic,
small children whose parents make and use the highly addictive drug.

The scars are inflicted in myriad ways: Exposure to the drug in the womb,
contamination from toxic chemicals used in home-based meth manufacture,
explosions and fires, long-term neglect from parents obsessed with their
drug habits, physical abuse and sexual abuse. Many of the meth-lab homes
are filthy, often strewn with drug paraphernalia and pornography;
meth-making chemicals have been found in diaper bags and toy chests.

"I've been in homes where you'd find jars of meth oil in the refrigerator,
but no milk, no bread for the kids," said Marvin Van Haaften, a former
country sheriff who is now Iowa's drug policy coordinator.

The meth epidemic took root on the West Coast, and is now worsening in many
big cities nationwide. But nowhere is its heartbreaking toll on young
children more evident than in the towns and small cities of America's
heartland -- notably Iowa, Missouri, Tennessee, Arkansas, Oklahoma,
Kentucky and Indiana.

Ingredients to make the drug, including common cold medicines, are often
readily available, and rural areas provide space for meth "cookers" to
operate undetected by neighbors or police.

Nationally, authorities have dismantled more than 50,000 clandestine meth
labs since 2001, including some 4,000 in Iowa. Roughly 30 percent are "mom
and pop" labs in homes where children live.

Thousands of children across the country have been taken away from their
meth-abusing parents in recent years, placed with relatives or shifted into
already overloaded foster care systems. Scores have been injured, a dozen
or more killed; thousands have been born with traces of meth in their bodies.

Dr. Rizwan Shah, a pediatrician at Blank Children's Hospital in Des Moines,
encountered her first meth-exposed child in 1993 and has studied more than
500 of them since, becoming a respected expert on the phenomenon.

She stresses that the prognosis for meth-exposed kids varies widely, and
strives to prevent them from being stereotyped. Some suffer serious brain
damage and others experience long-lasting development problems, while many
will grow into adults without serious health consequences, she said.

What's beyond doubt, Shah says, is that pregnant women using meth are
harming their babies.

"The brain gets hijacked by the drug," she said, describing patterns of
overstimulation and disrupted sleep cycles among infants, as well as
hyperactivity and attention-deficit disorder among meth-exposed school
children.

One 2-year-old boy Shah treats must be fed through a tube to his stomach
because meth exposure left him unable to swallow properly.

"Substance abuse wasn't taught in my medical school," Shah said. "The
people who use meth have been my teachers. They know, more than me, the bad
things the drug can do, but they keep using it, trying to repeat the
euphoria of the first time."

The mothers Shah meets often evoke meth's powerful lure -- an initial burst
of energy, a sudden and welcome ability to lose weight.

"Some of these women are trying to be good mothers," she added. "But when
you're high on meth, you don't take of yourself or your family. The older
kids are parenting the younger ones and also parenting the parent. They
lose their childhood to become caretakers."

Ottumwa, a meatpacking and slaughterhouse town of 25,000 in southeast Iowa,
has become a focal point of the state's efforts to aid meth-affected
children, both because of the steady caseload at Cheryll Jones' clinic and
because it is home to the country's first Moms Off Meth group -- a
self-help program for mothers trying to confront their addiction and
reorder their lives.

Sue Armstrong's children were ages 9, 4 and 3 when she started heavy meth
use seven years ago while managing a fast-food outlet.

"It made me feel able to do everything," she said. "Then it stopped
working, but I kept using it to cover up the shame I felt."

With Armstrong emotionally absent, her children were placed with relatives
for 18 months. Now she has them back after kicking her habit and getting a
job at a battered women's shelter.

"My oldest daughter keeps an eye on me -- she'll ask if I'm doing drugs
again," Armstrong said. "I'd rather she asked than didn't."

Kris Salisbury, another Moms Off Meth participant, had a 2-year-old
daughter when she started using meth in 1986. She bore twins in 1988, but
used meth for 10 more years until police raided her home where she and her
live-in boyfriend had set up a meth lab.

"There I was, sometimes, thinking I was a wonderful parent because my
oldest daughter would have hundreds of dollars I'd given her and could take
the twins to the movies," Salisbury said.

The reality was less rosy. She recalled the boyfriend abusing her in the
children's presence, grabbing her daughter by the hair, smashing some of
the kids' games with a hammer.

"I was an awful parent," said Salisbury, now a substance abuse counselor
who worries about the long-term repercussions for her children.

Both Salisbury and Armstrong were single mothers -- a fairly common
phenomenon among meth-affected families; so far, there has been no demand
for a Dads Off Meth program. And both women also were luckier than the many
meth-abusing parents who permanently lose custody of their children.

Iowa courts have handled scores of meth cases recently in which parental
rights were terminated. In one case, in which a father was arrested and a
brick of meth seized, authorities evacuated two dirty, lice-infested girls
- -- aged 31/2 and 21/2-- who had not been potty trained and still drank from
baby bottles.

Carol Gutchewsky, a regional supervisor of state social workers, said
addict parents trying to keep their children sometimes run out of time --
if a child's temporary relocation stretches past 22 months, the state is
obligated by federal regulations to seek termination of parental rights.

"It takes a long time to beat meth," Gutchewsky said. "While parents are
going through the treatment process, and maybe having a relapse, the clock
is ticking. The best interests of the child may be on a collision course
with the parents' treatment."

She recalled one mother who successfully beat her addiction, but not fast
enough.

"She called my agency and said, 'What are my options?' and we had to say,
'You're options are gone,"' Gutchewsky said. "She was given all the proper
chances, and she's a wonderful survivor. But by the time she got on top of
her addiction, her children were gone."

The coordinator of Iowa's year-old Drug Endangered Children program,
assistant attorney general Mary Chavez, empathizes with parents in such
predicaments and hopes politicians provide funds to expand and improve
treatment programs.

"But we want to keep the focus on the children," Chavez stressed. "You'll
find that no matter how horrendous their lifestyle, no matter how
neglectful they are, parents always think their kids are best off with
them. We have solid findings otherwise."

Under Iowa's current policies, which mirror those elsewhere, the Department
of Human Services has some discretion as to removing meth-exposed children
from home or giving addicted parents a chance to kick the habit -- but not
always.

"If we detect meth in a newborn, we're required to notify DHS," said Dr.
Resmiye Oral, pediatrician at the University of Iowa hospital. "The baby
gets medical follow-up and the mother goes to treatment. If she doesn't go
along with the plan, the baby is removed."

The number of meth-affected kids in the United States is difficult to
calculate, although Ron Mullins of the National Alliance for
Drug-Endangered Children says it is many thousands per year.

In Iowa, 5,887 children since 2001 have figured in abuse cases that
directly involve illegal drugs, mostly meth -- either traces of drugs were
found in their bodies or they were present while their parents manufactured
meth. But that figure does not cover a range of other cases in which the
abuse was classified as neglect, even though the parents' conduct stemmed
from meth use.

An ominous barometer was provided by Gutchewsky, who concluded after an
intensive study that meth played a role in roughly half the serious
child-abuse cases in her 16-county region -- 720 of 1,469 active, long-term
cases. If that ratio applied statewide -- which officials say is plausible
but not proven -- Iowa alone would be experiencing more than 6,000
meth-related child abuse cases per year.

"Folks are manufacturing clients for us faster than we can deal with it,"
said Ken Riedel, who oversees the Department of Human Services' meth
specialists. "In the 36 years I've been working, it's the single most
damaging problem I've dealt with."

The word "overwhelming" also surfaces frequently as officials discuss the
difficulty trying to properly care for Iowa's meth-exposed children and
combat the underlying drug epidemic.

An effective response, officials noted, requires coordinated action by law
enforcement officers, hazardous-material cleanup crews, health and social
service agencies, substance-abuse programs, the courts and the legislature.

Yet the problem is growing at a time of tight budgets and perennial
scarcity of foster homes. Many children are now taken in by grandparents
who may lack the stamina and savvy to handle troubled youth.

Judy Murphy, founder of Moms Off Meth, said mothers also need more support
in finding and paying for treatment programs. Many of them run a risk of
relapse, she said, when they try to retake control of their households
after completing treatment -- only to meet resistance from children who
have largely fended for themselves during the addiction.

The issue of limited resources has surfaced in a vigorous debate as to
whether Iowa should screen more newborn babies for exposure to drugs.
Policies vary from hospital to hospital; some test only a small fraction of
newborns.

Shah, the Des Moines pediatrician, believes expanded testing would uncover
many more drug-exposed babies -- but she worries that the state might be
unable to care adequately for the extra caseload of children and could not
afford treatment for their parents.

"It's a very daunting challenge," said Chavez, the assistant attorney
general. "We don't have the resources, but that doesn't take away the moral
responsibility to do screening, to intervene with the children as soon as
possible."

Without early intervention, the results have sometimes been fatal. A
1-year-old Des Moines girl, Brooklyn Petithory, died from a bathtub
accident suffered as her father was coming down from his meth high. A
Riverside, Calif., mother received a life sentence because her infant son
ingested meth from breast milk or tainted baby bottles. A Hawaii woman was
placed on 10 years probation in the death of her newborn son, which
authorities linked to her use of meth while pregnant.

Several states have toughened sentences in cases where meth is manufactured
in the presence of minors. In December, a 37-year-old Arkansas man was
sentenced to 50 years in prison for making meth in the mobile home he
shared with his 18-month-old son and pregnant wife.

In Des Moines, Chavez tries hard to be optimistic, insisting that -- with
proper resources -- Iowa's meth-exposed children have bright futures. The
alternative, she admits, is bleak.

"All they've been is neglected. All they've ever seen is the unacceptable,"
she said. "If we don't do something, they're going to be filling up Iowa's
prisons in a few years."