Abstract Parental substance misuse can harm children's development both directly and indirectly. This NSPCC report looks at what is known about babies affected by parental substance misuse, what effective or promising interventions are available, and what can be done to change policy in the area. Concludes that policy makers need to prioritise the needs of children and babies of substance abusing parents, and encourage an integrated, evidence-based and effective response. This report is part of the All Babies Count spotlight series on issues that affect families from pregnancy through the first years of life.