Published · Updated
Medically reviewed by Danesh Alam MD, DFAPA, DFASAM
No federal law requires hospitals to drug test newborns, and most states leave that decision to hospitals and clinicians. A few states require testing in specific situations. What federal law does require is that health care providers notify child protective services when a baby is born affected by prenatal substance exposure, withdrawal, or fetal alcohol spectrum disorder, and that states develop a "plan of safe care" for the baby and family. Cornell LII: 42 U.S.C. 5106a (CAPTA).
Florida does not require hospitals to test newborns either. But if a newborn is tested at birth and the result shows alcohol or certain controlled substances that did not come from medical treatment, Florida law treats that as "harm" to the child, which health care providers must report to the Florida Abuse Hotline.
This article is general information, not legal advice. If a child is in immediate danger, call 911.
What does federal law require?
The rule comes from the Child Abuse Prevention and Treatment Act (CAPTA), as amended in 2016 by the Comprehensive Addiction and Recovery Act. To receive CAPTA grants, a state must require providers who deliver or care for affected infants to notify child protective services, and must make sure a plan of safe care addresses the needs of both the baby and the family or caregiver. Cornell LII: 42 U.S.C. 5106a.
The law says this notification does not create a federal definition of child abuse or neglect and does not "require prosecution for any illegal action." It contains no testing mandate.
Are all babies drug tested at birth?
No. Practice varies from hospital to hospital. Medical groups recommend asking every pregnant patient about substance use, which is called universal screening, rather than testing everyone. ACOG Committee Opinion 711 (2017).
A 2024 review in Pediatrics says infant testing "should only be completed when it will inform clinical management," with consent obtained first, and notes "pervasive racial/ethnic disparities" in who gets tested. Pediatrics (2024): Care of infants with prenatal opioid exposure.
How newborn drug tests work
When checking for possible withdrawal, a care team asks about the mother's substance use and may test the baby's urine, first stool (meconium), or a piece of the umbilical cord. MedlinePlus: Neonatal abstinence syndrome. Each sample covers a different window:
- Urine only shows current or recent use. ACOG Committee Opinion 711
- Meconium can reflect exposures from as early as the end of the second trimester. It is passed in the first few days of life and can be hard to collect.
- Umbilical cord tissue is available right after birth, but most drugs do not build up in it, so its detection window is shorter. In one comparison it was about 35% less sensitive than meconium for opioid exposure.
ADLM: Umbilical cord tissue or meconium?
What a positive test can and cannot show
A positive result shows exposure. It does not show how much was used, how often, or whether a parent has a substance use disorder. ACOG notes that a positive test "is not in itself diagnostic of opioid use disorder," that false positives can happen, and that urine tests miss many substances, including synthetic opioids. ACOG Committee Opinion 711. Prescribed methadone or buprenorphine will show up on tests that look for them, so make sure the care team knows about every prescription.
Do hospitals need the mother's consent?
Medical groups recommend informed consent. ACOG says urine drug testing should be done only with the patient's consent and in line with state law, and that patients should be told about possible consequences of a positive result, including any mandatory reporting. ACOG Committee Opinion 711.
The U.S. Supreme Court has ruled that a state hospital's test done to get evidence for law enforcement is an unreasonable search without the patient's consent. That decision is narrow and does not cover all hospital drug testing. Cornell LII: Ferguson v. City of Charleston (2001).
Which states drug test babies at birth?
There is no single current list, because state laws differ and sources define "required testing" differently. The most recent national counts are Guttmacher's, as of July 1, 2023, cited by the National Conference of State Legislatures. NCSL: Substance Use Disorder and Parenting (2023). As of 2023:
- 25 states and Washington, D.C., considered substance use during pregnancy child abuse under civil child-welfare laws.
- 26 states and D.C. required health care professionals to report suspected prenatal drug use.
- 8 states required health care professionals to test for prenatal drug exposure if they suspected drug use.
- 5 states considered it grounds for civil commitment.
Guttmacher has since retired that state-policy page, so treat these as dated counts. Guttmacher: State laws and policies.
One current example: in Minnesota, a physician must test a pregnant patient, or a patient within eight hours after delivery, whose obstetrical complications medically suggest nonmedical controlled-substance use. A physician must also test a newborn when a medical assessment suggests the mother used a controlled substance for a nonmedical purpose. Positive results must be reported. Minnesota Statutes 260E.32.
Laws also change. Tennessee's 2014 "fetal assault" law allowed prosecution related to narcotic use during pregnancy, but it expired in July 2016. PBS NewsHour: Tennessee discontinues fetal assault law.
Whether you are looking for 2021 rules or 2026 rules, the current federal requirements date to the 2016 amendments. State rules are what vary, so check your state's current law or ask your hospital.
Does California test newborns for marijuana?
This article does not cover California's specific rules. Whether a baby is tested, and for which substances, depends on state law and hospital policy. If you live in California, ask your prenatal provider or delivery hospital how they handle testing and reporting.
Does Florida drug test newborns?
Florida law does not require hospitals to drug test newborns or pregnant women. Its child-welfare law instead spells out what a positive test at birth means. Florida Statutes 39.01.
Florida's routine newborn screening for metabolic, hereditary, and congenital conditions is a separate program, not a drug test, and parents may object to it in writing. Florida Statutes 383.14.
What Florida's law says about a positive test
Under Florida's definition of "harm," a child's exposure to alcohol or a controlled substance can be established by "a test, administered at birth," showing any amount in the baby's blood, urine, or meconium, "the presence of which was not the result of medical treatment administered to the mother or the newborn infant." It can also be established by evidence of extensive, chronic parental use that severely compromises the parent's ability to care for the child. Florida Statutes 39.01.
For this purpose, "controlled substance" means prescription drugs not prescribed for the parent or not taken as prescribed, plus Schedule I and Schedule II drugs. Florida lists cannabis as Schedule I and fentanyl and methadone as Schedule II. Buprenorphine is Schedule III. Florida Statutes 893.03.
By its wording, the statute excludes medical treatment and prescription drugs taken as prescribed, such as prescribed methadone or buprenorphine. That is the statute's text, not a guarantee about any individual case, so ask a lawyer about your own situation.
Florida also requires neonatal abstinence syndrome cases to be reported to the state health department. That is public-health tracking, separate from a child-welfare report. CDC MMWR: State-mandated reporting of NAS (2019).
Can medical staff call child protective services if a baby is born with drugs in its system?
Yes. CAPTA requires participating states to have providers notify child protective services about affected infants. In Florida, anyone who knows or has reasonable cause to suspect child abuse or neglect must report it immediately to the central abuse hotline, and physicians, nurses, and hospital staff must give their names. Florida Statutes 39.201.
The Florida Abuse Hotline is 1-800-962-2873 (1-800-96-ABUSE), available 24/7. Florida DCF: Florida Abuse Hotline.
What happens if a baby tests positive for drugs at birth?
In Florida, a positive test that meets the statute's definition leads to a report and a child protective investigation. A report does not automatically mean the baby is removed.
- Investigation. Urgent reports go to investigators immediately. The investigator looks for present and impending dangers to the child. Florida Statutes 39.301.
- Safety plans. Where danger exists, the investigator must put a safety plan in place or take the child into custody. A safety plan can be in-home or out-of-home. If no adequate plan can be made, the department must file a shelter petition with the court.
- Voluntary services first. Services are first offered for voluntary acceptance unless there are high-risk factors or other listed concerns. The investigation must generally be completed within 60 days of the report.
Florida procedure also requires attending health care providers to refer prenatally exposed infants for early intervention services. A plan of safe care is discussed with the family and developed if the family agrees there is a need. In Florida, "a POSC is always voluntary." Child Welfare Information Gateway: Plans of safe care in Florida.
Florida treats a positive newborn test as a child-welfare matter under chapter 39 of its statutes. Child Welfare Information Gateway: Parental substance use as child maltreatment in Florida.
When do they drug test during pregnancy?
ACOG recommends screening every pregnant patient at the first prenatal visit using validated questionnaires. A urine drug test should be done only with the patient's consent and in line with state law. ACOG Committee Opinion 711. The CDC also recommends early universal screening, brief intervention, and referral to treatment for pregnant women. CDC: Opioid use and pregnancy.
Some states, such as Minnesota, require testing in certain situations.
Newborn withdrawal: NAS and NOWS
Neonatal abstinence syndrome (NAS) is withdrawal after birth in a baby exposed to opioids during pregnancy. Neonatal opioid withdrawal syndrome (NOWS) is the opioid-specific term. Alcohol, benzodiazepines, and some other medicines can also cause withdrawal symptoms. MedlinePlus: Neonatal abstinence syndrome.
Symptoms often start 1 to 3 days after birth, so babies are usually watched in the hospital for about a week. Signs include high-pitched crying, poor feeding, vomiting, tremors, sleep problems, and seizures. Care starts with comfort measures such as gentle rocking, a quiet room, and skin-to-skin contact, and some babies need medicine that is tapered over time. MedlinePlus: Neonatal abstinence syndrome. In one trial, the "Eat, Sleep, Console" approach got babies ready to go home 6 days sooner. Pediatrics (2024).
In 2023, the U.S. rate was 5.1 NAS diagnoses per 1,000 birth hospitalizations, and Florida's rate was 4.7. America's Health Rankings: Neonatal abstinence syndrome. For comparison, in 2014 the national rate was 8.0 per 1,000, about one baby every 15 minutes. CDC MMWR (2019).
Babies whose mothers take prescribed methadone or buprenorphine can still develop NOWS. It is expected and treatable, and not a sign the treatment was wrong.
If you are pregnant and using opioids or other substances
If you use opioids, do not stop suddenly on your own, because withdrawal carries possible risks for you and your baby. The CDC says medication treatment with buprenorphine or methadone is recommended and preferred over tapering off. CDC: Opioid use and pregnancy. ACOG also encourages breastfeeding for women who are stable on these medicines, are not using illicit drugs, and have no other reason to avoid it. ACOG Committee Opinion 711.
Pregnant women get priority admission to treatment programs funded by federal block grants. If no program can admit her, the state must offer interim services within 48 hours. Cornell LII: 45 CFR 96.131.
For free, confidential help finding treatment 24/7, call the SAMHSA National Helpline at 1-800-662-4357 (TTY 1-800-487-4889). If you are having thoughts of suicide, call or text 988. SAMHSA National Helpline.
Getting help at Ambrosia
If you are pregnant and struggling with opioids or other substances, talk with your prenatal provider about medication treatment, and call our admissions team to ask whether our programs are a fit for your situation. Ambrosia offers medication-assisted treatment through our detox center in West Palm Beach, opioid addiction treatment, a women's program, and dual diagnosis care for people facing substance use and mental health concerns together.