The "drug-exposed" children won't be the only ones affected. Their hyperactivity and impaired learning ability will demand extra attention from teachers.
"Their numbers need to be multiplied 20 to 40 times, because each of these children will end up in a classroom with 20 to 40 other children," said Allan Shedlin Jr., executive director of the Elementary School Center, a New York organization that studies early-childhood education.
Not only is there confusion about how to handle children exposed to drugs, no one is quite sure how many there are - nor can experts predict when their numbers might subside.
Data collected from maternity hospitals show that 375,000 babies are born each year with drugs - including alcohol - in their systems.
But because many women stop using drugs shortly before they give birth and escape detection, the actual number of infants exposed to drugs in the womb may run much higher - 500,000 to 750,000 per year, or nearly 20 percent of all newborns.
The National Institute on Drug Abuse estimates that 4.5 percent of all newborns are exposed to cocaine in the womb.
Physicians say the long-term damage to the fetus from maternal drug abuse still needs study. Cocaine, which severely constricts blood vessels in the brain, has proven the most damaging in isolated research by the National Association for Perinatal Addiction Research and Education (NAPARE) and other groups.
Evelyn Davis, a pediatrician at New York City's Harlem Hospital, has tracked the development of about 1,900 children born with cocaine in their systems between January 1986 and December 1990. That represents 13 percent of all births at the hospital.
Of the 1,900 babies, more than a third were premature. Fifteen percent have ''lifetime handicaps," such as mental retardation, cerebral palsy or blindness because of strokes in the womb, Davis said. Nearly all of the remaining 85 percent have some less-serious affliction that emerged later: hyperactivity, impaired motor skills, delays in language use.
"They often reach age 2 without saying their first two words - Mommy and Daddy - and reach age 5 without the ability to speak phrases," Davis said.
But, she added, those with delayed development "are able to make contributions to society if we get to them early enough."
The early response has been concentrated in a relative handful of large school districts and less than a dozen states - including California, Florida and New York - that have authorized expansions of their own preschool and special-education programs.
On the federal level, Congress last year authorized pilot programs in a half-dozen cities to study the developmental needs of these children, but they were never funded.
For 1991-92, the Bush administration is proposing a new Early Childhood Research Institute that would coordinate the studies, according to Robert R. Davila, assistant education secretary for special education and rehabilitation services. The President has recommended a five-year budget of about $800,000 per year.
Davila said that money was in addition to federal aid offered to states for early-childhood services that can include drug-exposed children. Thirty-eight states receive federal funds for programs serving 247,000 infants and toddlers with disabilities. And the government offers grants averaging $1,204 per child for special preschool programs that include disabled children, with more than 367,000 children ages 3 to 5 enrolled this year.
U.S. drug policy chief Bob Martinez also said pregnant women would get top priority under a $100 million expansion of drug-treatment programs recommended by President Bush.
But many education experts and members of Congress said that promise didn't go far enough - and it didn't confront the issue of what to do with the children entering school this fall.
A bill known as the Children of Substance Abusers (COSA) Act passed the Senate Labor and Human Resources Committee on July 17. It would allocate $100 million a year, starting Oct. 1, to help train teachers and expand family- assistance programs, as well as treat pregnant women with drug problems. Funding for that plan, sponsored by Massachusetts Sen. Edward M. Kennedy and a dozen other Democrats, is involved in the continuing budget negotiations.
House committees, still drafting proposals, are focusing on immediate aid for school systems.
But one key player, Rep. Major Owens (D., N.Y.), chairman of the House Education and Labor subcommittee on select education, said he was worried that unless the Bush administration agreed to come up with more money, educators would be forced to develop a "triage" system for drug-exposed children that ''helps only with those considered high enough priorities."
At the same time, a few conservatives questioned whether women who choose to abuse drugs during their pregnancies deserved help.
"A lot of people whose tax money would be spent for special education want to know whose fault is it?" said Rep. Michael Oxley (R., Ohio). "You're asking our constituents to pay for personal irresponsibility" by the mothers.
But experts like Davis said drug addiction must be thought of as a disease, not thrill-seeking or simple stupidity.
One NAPARE study, in the St. Petersburg, Fla., area, found that white mothers-to-be from the suburbs were just as likely to be using cocaine as minority mothers-to-be from the city, said NAPARE executive director Judith Burnison.
Just as important, insisted Burnison, is that the children didn't make the choice to be born this way, and they deserve help.
"Writing off hundreds of thousands of children as 'lost' will only create a self-fulfilling prophecy and will burden various social service, education and medical agencies to their limits" with longer-term costs, Burnison said.