Almost all studies of prenatal cocaine exposure document negative growth effects on the fetus. Few studies report a dose-response relationship or report data beyond birth. We report growth data from birth-18 months on children participating in a longitudinal study of the effects of prenatal cocaine exposure. Women were prospectively enrolled from rural health departments as they came in for prenatal care or arrived at the hospital for delivery. Of 2,526 women approached, 85% consented to the study's interviews and urine screens, from which 154 were identified as cocaine users and matched on prenatal risk, race, parity, and socioeconomic status to 154 consenters verified as non-users. Women were >18 y/o, had no prenatally diagnosed chronic illness, no use of other illicit drugs except marijuana, and no chronic use of prescription drugs or other medications. Urine toxicology screening was done at two unanticipated times. Histories were taken at the end of each trimester and along with child growth measures at 1, 6, 12, 18, 24, and 36 months of age. Cocaine use was quantified using drug history. Four categories of use were analyzed: high (≥ $2/day), low, non-admitters (urine+;history -), and non-users. Analyses based on amount of drug usage used one-way ANOVA with comparison of means using a Multiple F Test. Analyses of growth, adjusting for prenatal exposure to alcohol, nicotine, and marijuana, race, gender, gestational age, and time were made using multiple regression with two-way interaction terms for all the variables. At birth, cocaine was significantly related to lower WT and smaller HC. The non-admitters differed significantly from the non-users with lower WT and smaller HC and from the high users with smaller HC. By 1 month, cocaine no longer had a significant effect on WT or HC. There was no relationship between cocaine exposure and growth from birth to 18 months, however alcohol had strong, significant effects on WT and LT. Our study shows catch-up growth in WT for the cocaine-exposed infants by 1 month of age. Unlike previous studies, we demonstrated catch-up growth in HC by 1 month, as well. We were unable to show a relationship between amount of cocaine exposure and growth. These findings are meaningful given our low attrition, resulting in a sample size large enough to show differences if they existed, and provide guarded optimism for the outcome of these children.