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Human milk is the best source of nutrition for infants. Breast milk contains the optimal balance of fats, carbohydrates, and proteins for developing babies, and it provides a range of benefits for growth, immunity, and development. Unfortunately, breast milk is not pristine. Contamination of human milk is widespread and is the consequence of decades of inadequately controlled pollution of the environment by toxic chemicals. The finding of toxic chemicals in breast milk raises important issues for pediatric practice, for the practice of public health, and for the environmental health research community. It also illuminates gaps in current knowledge including a) insufficient information on the nature and levels of contaminants in breast milk; b) lack of consistent protocols for collecting and analyzing breast milk samples; c) lack of toxicokinetic data; and d) lack of data on health outcomes that may be produced in infants by exposure to chemicals in breast milk. These gaps in information impede risk assessment and make difficult the formulation of evidence-based health guidance. To address these issues, there is a need for a carefully planned and conducted national breast milk monitoring effort in the United States. Additionally, to assess health outcomes of toxic exposures via breast milk, it will be necessary to examine children prospectively over many years in longitudinal epidemiologic studies that use standardized examination protocols that specifically assess breast milk exposures. Finally, current risk assessment methods need to be expanded to include consideration of the potential risks posed to infants and children by exposures to chemical residues in breast milk.