Brad Sawhill saw the dope pipe on the kitchen counter and gave his girlfriend of three weeks an ultimatum. She chose drugs; he never saw her again.

Seven months ago, there was a knock on Sawhill’s door. A worker from the state department of social services wanted him to take a paternity test. His former girlfriend had had a baby, Katlyn, and the child’s foster family wanted to adopt her, but the state first had to notify her father.

From her round blue eyes to the sprouting tufts of sandy blonde hair, Katlyn, now 16 months old, is the mirror image of Sawhill, a 31-year-old warehouse worker in Des Moines. In early July, a judge granted Sawhill legal custody of Katlyn, and her mother’s name was removed from her birth certificate. Now he is experiencing the test of a lifetime: How to care for a meth-exposed child.

"I'm trying to do the best I can," he says. "She's my kid; I'd give her anything. But I hope that she could be normal."

Katlyn silently squirms across the hospital floor on her belly, rapidly flitting her little legs like a fish out of water as she inches closer to the toy block on the blanket. Her glazed eyes widen as she reaches for the green block next to the rattle. But as she grabs the toy, her body stiffens, her legs straighten, and her eyelids flicker.

Katlyn starts to shake. She stops three seconds later, then continues to push herself across the floor. She bangs her head on the ground. Katlyn can’t walk or talk. She has experienced two seizures and is on medication to prevent a third. Her left hand awkwardly wavers during an exercise to place a green block in a cup. It's a task to test her motor skills, her physician Rizwan Shah explains, but the toddler misses the mark. Katlyn has suffered some neurological damage and is six to eight months behind in her development.Shah suggests she learn sign language.

Shah, who has known Katlyn since she was born, believes Katlyn was affected by her mother’s meth and marijuana use during pregnancy.

"Unfortunately, all of this could have been avoided," Shah tells Sawhill as he watches his daughter from a corner. "But you're doing the right thing. You're trying to pick up the pieces of her life."

Shortly after she was born, Katlyn was placed with a foster family. At Shah’s pediatric clinic at Blank Children’s Hospital in Des Moines, nearly 70 percent of the meth-affected babies and children Shah examines are in the foster care system.

On the second floor, where doors are decorated with paintings of smiling children and dancing hearts, Shah attends to infants who had strokes while inside their mother's wombs; toddlers who feel as if bugs are crawling on their skin and scream when they are touched; and children who have inexplicable and uncontrollable outbursts of rage.

At least two meth-exposed babies are born in Iowa weekly, Shah says. At the hospital, Shah works with 280 such patients, including Katlyn. Shah monitors their muscle, nerve and neurological development to try to give the children, their parents and caregivers an idea of what will happen next or how best to work through future problems.

"I haven't followed these kids for a long time," she says. "I don't know what will happen to them as they grow older."

No long-term medical studies have been done on meth-exposed children. Shah started the pediatric program to track drug-exposed babies in 1989, before meth became a problem in the Midwest. At the time, she worked primarily with babies affected by crack cocaine. In 1993, she saw her first meth-affected baby, and since then she has focused on comparing the prenatal effects of both drugs.

Methamphetamine, she says, causes more severe damage to babies because meth stays in a woman's body longer - four times longer on average.

Shah tells Sawhill that Katlyn should undergo speech and physical therapy until she is five or six years old. She then explains the services available and the people he can contact for more information.

"Nothing is set in stone," she says in a reassuring voice. "If you provide intervention early on, the outcome in the long-run is better than if the child is left alone.” Shah tells Sawhill to call her anytime. She admits her work is personal.

"You cannot have the science of medicine without the heart of medicine," she says. "A long time ago, when doctors did not have all these wonder drugs, treatment and technology, they provided the best of care just by sitting with people and holding their hand through the tough times."

She will see Katlyn again in three months.

Sawhill pulls a green Bambi shirt over Katlyn's head and tries to put on her flower-printed shorts and shoes. She starts to cry.

"I'm afraid every day; I don't know what's going to happen," Brad says, his eyes tired.

Katlyn is slowly improving. She can digest her medication and she hasn’t had a seizure since May. Brad says his mother is helping him care for Katlyn while he works. He hasn’t heard from Katlyn's mother.

"I don't wish her (mother) any harm," he says. "But I hope someday she could realize what she's done."

-- By Crystal Carreon