Perceptual responses to infant distress signals were studied in 16 cocaine-using and 15 comparison mothers. All mothers rated tape recordings of 48 replications of a newborn infant's hunger cry digitally altered to increase in fundamental frequency in 100-Hz increments. Cries were rated on 4 perceptual (arousing, aversive, urgent, and sick) and 6 caregiving rating scale items (clean, cuddle, feed, give pacifier, pick up, and wait and see) used in previous studies. Analyses of variance showed that, as cry pitch increased, cries were rated as more arousing, aversive, and urgent sounding. The highest pitched cries received the highest ratings for caregiving interventions. Main effects for cocaine use showed cocaine-using mothers (a) rated cries as less arousing, aversive, urgent, and sick; (b) indicated they were less likely to pick up or feed the infant; and (c) indicated they more likely to give the crying infant a pacifier or just "wait and see." A Group × Cry Pitch interaction effect showed that mothers in the cocaine group gave higher ratings to wait and see as the pitch of the cries increased, whereas mothers in the comparison group gave lower ratings to wait and see as the pitch of the cries increased. These ratings indicate that cocaine-using mothers found cries to be less perceptually salient and less likely to elicit nurturant caregiving responses. These results suggest that maternal cocaine use is associated with altered perceptions of infant distress signals that may provide the basis for differential social responsivity in the caregiving context.