This article describes the early history of the "boarder baby" phenomenon through the late 1980s and early 1990s. The characteristics of the recent "boarder baby" population and of the problem are described with particular emphasis on the role of alcohol and drug abuse and the historical lack of coordination between hospitals and child welfare agencies. Three additional topics are discussed in depth: (1) policies around testing mother and infants, (2) the meaning and use of a positive toxicology screen for a newborn or birthing mother, and (3) the identification and characterization of the victim. Alternative solutions to the problem are discussed.