Schneck H. J Pediatr 1958;52:584-87 No longer does one need to go to a medical journal to read about drug abuse and addiction; the lay media reports on the drug culture, drug lifestyle, drug cartels, drug gangs, drug connections, death from drugs, and drug rehabilitation. Our vocabulary has special meaning with reference to drugs; we routinely speak of “highs,” “cold turkey,” “speed,” “crack,” and “mainlining,” to name only a few terms. The 2004 National Survey on Drug Use and Health estimates that 19.1 million Americans age 12 years and older use illicit drugs.1Substance Abuse and Mental Health Services Administration (2005). Results from the 2004 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-28, DHHS Publication No. SMA 05-4082). Rockville, MD.Google Scholar We hear and read of people in high profile professions (eg, entertainers, athletes, politicians) who succumb to drugs, confront the law, and seek medical intervention. Actually, the problem of drug addiction cuts across all demographic boundaries of society, affecting even the most vulnerable and helpless—the newborn and unborn. Fifty years ago, Dr Schneck reported on an infant born to a mother addicted to heroin. Today we are dealing with dependence on an array of drugs including narcotics, hallucinogens, barbiturates, benzodiazepines, amphetamines, methamphetamine, cocaine, marijuana, alcohol, nicotine, inhalants, and antidepressants, and combinations of these drugs. The signs of withdrawal in the newborn described by Schneck have been expanded and systematized to guide evaluation and treatment. The principles of care for the withdrawing newborn are primarily supportive and have not changed much in 50 years. Treatment drugs should match the class of agents from which the infant is withdrawing. The aim of pharmacologic therapy is to make the infant comfortable but not obtunded. Weaning from the drug should be gradual. In the past, mortality was secondary to diarrhea, vomiting, fever, and fluid and electrolyte imbalance as a consequence of withdrawal. Today, death is rare but can result from complications of abuse during pregnancy, such as prematurity, low birth weight, meconium aspiration, sepsis, and cerebral infarction. Laboratory analysis of meconium, hair, and urine can confirm drug exposure. Data on long-term outcomes include delayed physical and mental development, learning disabilities, and hyperactivity. Other risks include ongoing exposure to illicit drugs (either passively or by accidental ingestion), abuse, and sudden infant death syndrome. We are faced with a national drug problem of epidemic proportions and pediatricians care for some of its unwitting victims. We need to be vigilant, compassionate, and effective in our management of the infant and the drug-dependent mother.