Cocaine is one of the most widely abused substances in the United States, in part due to the availability of its inexpensive alkaloidal free-base form, "crack". A variety of medical complications, including sudden death, are known to occur in the adult-user population, regardless of the route of cocaine administration. We report 16 cases of infant death registered by the Philadelphia (Pa) Medical Examiner's Office over a 2-year period (1987 through 1989), where toxicologic analyses revealed the presence of cocaine and/or its metabolite, benzoylecgonine. Scene investigation documented that these infants, shortly before death, had been exposed to environments that contained the smoke from crack. We conclude that the route of cocaine administration in this infant population was the passive inhalation of crack smoke. It is possible that the cocaine may have contributed to the death of these infants. Thus, in addition to the adult users, infants and children exposed to environments where crack is smoked may inhale cocaine and potentially suffer from its adverse effects.