In response to the past couple of postings on alcohol and cocaine and breastfeeding, I am currently away from my office and all my articles on the subject but I will post some references as soon as is humanly possilble. All of this is to be considered as my humble but strongly felt opinion. One of my first thoughts is not in the nature of punishment but of education and support for this mom. First the mom ought to be commended for providing her baby with the best possible nutition for her wee one. Secondly this is a mom with obvious drug use/abuse issues and this ought to be seen as a valuable opportunity to intervene with her on her addiction. Often the birth of a child is an opportunity for these women to turn their lives around but they need a non judgemental supportive honest approach. It also goes without saying that she must be informed of the risks to her baby of her prenatal and now her postnatal drug use on her baby and on her ability to safely parent. We cannot assume that she is aware of these risks. Another and no less important issue is the obvious misinformation on ths part of the Child Protactive Services. The issue is not whether or not her drug of choice is a controlled substance or not but rather its effects on her ability to safely parent and the effects of her continued use on her new infant (and any other children she may have in her care). Their involvement does not necessarily have to take the form of removing the child from this mother's care but must include support for this mom to deal with her addiction (detox, recovery home, homemaking services, parenting education etc). And if this child's immediate safety is an issue it must include removal at least on a temporary basis (and I would personally advocate for her ongoing involvement through visitation). This family needs close follow up by pediatrician,lc, public health nurse, and CPS. A thorough history should be taken of all drug use in each trimester. Growth should be monitored particularly weight and HC. This mom should know that her baby is at an increased risk of SIDS from prenatal and postnatal substance exposure and of second hand smoke if she is smoking in the same home as her infant. This child should also be monitored closely for signs of neonatal withdrawal and of the neurodevelopmental sequelae of prenatal substance exposure. (This is a lengthy post already so if anyone is interested in a more thorough explanation please email me privately). As well if her use is continuing the child continues to be at risk of ongoing exposure through her breastmilk. IMHO Paula Robeson RN BN CBC