The past three decades have been marked by an increasing recognition of the responsibility of pediatricians to their patients and their patients' families regarding the diagnosis and management of abuse of tobacco, alcohol, and other substances of abuse including prescription drugs. Because of the harmful consequences, substance abuse is an obvious concern for all those who care for infants, children, adolescents and young adults. When it occurs during pregnancy, it has been associated with an increased incidence of prematurity; congenital defects, including brain damage; and even death.

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