Source: San Jose Mercury New (CA) Section: Kids' Health Author: Sara Solovitch Contact: Wed, 4 Mar 1998 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 to (408) 271-3786, or mail them to Kids' Health, the Mercury News, 750 Ridder Park Drive, San Jose, Calif. 95190.