Public discussions of infant death and substance use often lack clinical nuance, which can unintentionally increase stigma and blame toward grieving mothers. This article aims to clarify what we know about Sudden Infant Death Syndrome (SIDS), substance use in pregnancy, and the designation “Infant of a Substance-Using Mother (ISAM),” while emphasizing compassion, evidence, and the limits of our current understanding. Here are some facts about SIDS: The occurrence of SIDS has