Neonatal Opioid Withdrawal and Neonatal Abstinence Syndrome
A guide for families
What is neonatal opioid withdrawal syndrome (NOWS) or neonatal abstinence syndrome (NAS)?
At birth, your baby no longer gets the drug(s) he or she was used to getting from your blood during pregnancy. When the effects of the drug(s) suddenly stop, your baby may develop symptoms called withdrawal. We understand that each person takes medications or drugs for different reasons. No matter the reason, we are here to help you learn about NOWS/NAS and how to help take care of your baby.
What are the symptoms of NOWS/NAS?
Each baby will have a different group of symptoms, but there are some common symptoms you might see. These symptoms are very real and can be painful to your baby.
How are withdrawal symptoms treated?
Keeping your baby comfortable will help him or her cope with symptoms of withdrawal. However, if your baby’s symptoms increase, he or she may also need medication. To decide if your baby needs medication, we measure your baby’s symptoms using the Eat, Sleep, and Console (ESC) care tool method. The ESC method is helpful for babies specifically withdrawing from opioids. After your baby is done feeding is a good time for you and the nurses to check your baby’s symptoms.
The nurses will keep track of:
- How well your baby eats
- How well your baby sleeps
- How well your baby consoles (calms)
- What kinds of things you and the nurses are doing to help console or calm your baby (skin to skin, holding, swaddling, dark or quiet rooms, rhythmic movement, etc.)
- What your baby’s stools (poops) are like (loose, watery)
How long will a baby with NOWS/NAS stay in the hospital?
Every baby is an individual and will need different levels of treatment. Some babies will require medication to help with withdrawal. It is not safe to suddenly stop the medication, which can cause complications including seizures. Your baby’s medication will be gradually reduced over time. This process is called “weaning.” Weaning may take a few days to several weeks or longer.
Your baby is usually ready to go home if he or she:
- Is feeding and sleeping well
- Is easy to console (calm)
- Is gaining weight or has not lost too much weight
- Can keep a healthy temperature and vital signs
- Has received all routine newborn care
- No longer needs medication
- Has follow up plans in place with a primary care physician
What happens if your baby needs medicine to treat withdrawal?
Some babies need only one dose of medicine, while others need to be treated for several days or weeks. It is very important that you try to stay with your baby as much as possible during this time because you play a role to help treat your baby. If possible, plan to have at least one family member or friend here with you to help care for your baby in the room. If it is hard to talk to your family about why your baby might need to stay in the hospital, your OB or pediatric provider or social worker can help you with this or any other difficult conversations.
You play an important role in helping your baby get home as soon as possible.
- Watch for your baby’s signs of stressful behavior and learn as much as possible about your baby’s needs. Helping your baby stay calm and comfortable is the best medicine he or she will ever receive. If you have any questions, please ask your nurse or another member of the healthcare team.
Common symptoms and methods to calm your baby:
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Behavior
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Calming suggestions
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Prolonged or high- pitched crying
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Hold your baby close to your body, skin to skin or swaddled in a blanket.
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or hyperactive movements
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(Crying that lasts a long
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Decrease loud noises, bright lights
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time or is louder than normal)
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and any excessive handling.
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Gently rock or sway your baby while humming or singing quietly.
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Offer a pacifier.
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Sleeplessness
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Reduce noise, bright lights, patting or
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(Problems falling or
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touching your baby too much.
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staying asleep)
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Play soft, gentle music.
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Gently rock or sway your baby while humming or singing.
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Change your baby’s diaper if it is dirty.
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Check for and treat diaper rash with a lotion or skin barrier cream.
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Offer a pacifier to help your baby go back to sleep.
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Sneezing, stuffy nose
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Keep your baby’s nose and mouth
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clean with a soft washcloth.
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Do not suction your baby’s nose unless there is drainage. Why? Frequent suctioning of the nose can make the stuffiness worse.
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Breathing troubles
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Avoid overdressing or wrapping your baby too tightly.
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Always have your baby sleep on his or her back, never on their tummy.
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Call your baby’s provider if your baby is having trouble breathing.
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Spitting up
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Burp your baby each time he or she stops sucking while feeding.
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Hold your baby upright for a period of time after feeding.
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Feed smaller amounts and more often.
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Behavior
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Calming suggestions
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Loose or watery stools
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Be gentle when changing the diaper.
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Discontinue wipes and use warm water with a soft washcloth.
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Put skin barrier cream on their bottom for protection.
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Trembling
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Keep your baby in a warm, quiet room.
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Avoid excessive handling of your baby during care routines or when people come to visit.
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Fever
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Do not overdress or overbundle your baby.
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Report a temperature greater than 100.4˚F or 38˚C to your baby’s doctor.
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Excessive sucking of fists
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Feed your baby when he or she is
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hungry and until content.
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Offer a pacifier or finger if your baby wants to suck but isn’t hungry.
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Cover your baby's hands with mittens or sleeves if the skin becomes raw.
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Keep areas of damaged skin clean.
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Avoid lotions or creams on the hands as the baby may suck on them and swallow these products.
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Difficult or poor feeding
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Feed your baby when he or she is
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hungry and until content.
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Feed in a calm and quiet area.
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Feed your baby slowly.
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Allow your baby to rest a little during and after the feedings.
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Help your baby feed by supporting his or her cheeks and lower jaw.
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Do not rock or stimulate your baby while bottle-feeding.
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ESC Care Tool
This chart will be used by your registered nurse and medical team to assess how your baby is doing and what treatment your baby needs:
These things make my baby happy:
These things make my baby unhappy:
These things seem to calm my baby:
Resources:
· marchofdimes.org/complications/neonatal-abstinence-syndrome-(nas).aspx
· ACT NOW ESC Parent Guide