The nationwide telephone survey of child welfare supervisors from 2 urban and 2 rural counties in each State yielded 200 complete responses. All but one of the respondents were county-level child welfare supervisors or workers identified by local staff as the person in that county who was most familiar with the practice regarding infants with prenatal drug exposure. One respondent was a public health nurse who worked with child welfare services in her county. The questionnaire solicited responses on several issues, including whether they received referrals of infants with prenatal exposure to drugs; how they petitioned for court involvement or used preventive services designed to avoid court involvement; how often they took custody of infants with positive drug screens; and whether they viewed their county's practice as too strong, appropriate, or inadequate to protect the child. In addition, questions on frequency of child custody removal were asked separately for infants who tested positive for cocaine, for amphetamines/opiates, and for marijuana. Ninety percent of counties (100 percent of urban and 80 percent of rural) reported receiving referrals of infants with prenatal drug exposure. Among those receiving such referrals, there were significant variations in practice. All possible response options, ranging from inactive to very aggressive, were equally represented on key issues, e.g., filing court petitions and taking custody. Rural counties tended to respond more strongly than urban counties. County response did not vary with county-level median family income, percent minority births, or birth rate. Despite wide variations in practice, the majority of respondents (69 percent) viewed their county's response as appropriate. Of the respondents who reported that their county's response to infants with prenatal drug exposure was inappropriate, 85 percent wanted the county to do more to protect such children. 2 tables, 1 figure, and 12 references