Also Known as Neonatal Opioid Withdrawal Syndrome (NOWS)
Neonatal abstinence syndrome (NAS), or neonatal opioid withdrawal syndrome (NOWS), is a condition that starts at birth after a baby was exposed to drugs, legal or illegal, during pregnancy.
When the baby is born, their drug supply stops and they go through a time of withdrawal. Until the drugs have left the baby’s system, they feel discomfort. This is like when an adult suddenly stops using drugs.
Signs and Symptoms
The withdrawal signs a baby has depends on what drugs are in their system, how much they were exposed to and how they were used during pregnancy.
Some typical signs of withdrawal may be:
- high-pitched cry
- shaky (tremors)
- cranky, restless
- hard to get or keep asleep
- stiff body
- throwing up (vomiting)
- little weight gain
- feeding problems
- diarrhea or frequent stools
- severe diaper rash
- stuffy nose or repeated sneezing
- forceful sucking
- skin irritation
- frequent yawning
- seizures (rare)
Some babies have mild signs of withdrawal and need only normal, newborn baby care. Non-medical treatment is preferred. However, some babies have severe withdrawal and need medical treatment. Treatment may include being admitted to a special care nursery. There, your baby can get medicine to help ease their distress. If your baby is in a special care nursery, providers will be watching them to decide what care they need.
Things You Can Do
You can do these things at the hospital, or at home:
- Give your baby a pacifier.
- Pat or rock your baby.
- Hold your baby close. You might try using a skin-to-skin method called kangaroo care (Picture 2).
- Learn the signs of withdrawal so you will know if your baby is getting worse.
- Change your baby’s diaper often. Clean their skin with warm water.
- Give smaller, more frequent feedings.
- Spend a lot of time with your baby, in the nursery or at home. Your baby will be comforted by your contact.
- Keep the setting calm and quiet. Keep lights dim, TV and radio off and use soft, quiet voices. Babies that have NOWS/NAS, are sensitive to stimulation, like bright light, loud sounds and being moved or held often.
- Use a blanket to wrap your baby, but be careful not to overheat them.
- Keep in contact with your child’s health care provider.
- Breastfeeding is encouraged. However, if you are not breastfeeding, your baby’s health care provider will tell you what formula is best.
- To help with digestion, your baby may need a special formula.
- Often, babies will need to suck but not eat. In that case, you can give them a pacifier.
- During the first week of life, a baby will eat 1/2 to 1 ounce of milk per feeding. After that, they will usually eat 2 to 3 ounces of milk per feeding. Feeding more than this can lead to vomiting and diarrhea.
Your baby’s health care provider may prescribe medicine to help with their withdrawal.
- Give your baby the exact dose of medicine prescribed. Give only the amount of medicine that the health care provider prescribes.
- If you forget a dose of medicine, but remember within about an hour, give it right away. Then, go back to your regular dosing schedule.
- If you do not remember until later, do not give the missed dose at all. Do not double the next one. Instead, go back to your regular dosing schedule.
It is important to watch your baby’s development as they grow. Talk to your baby’s health care provider about any questions or concerns you have. Children who have been treated for NOWS/NAS in a special care or intensive care nursery may be referred to the Neonatal Developmental Clinic for more specialized care. A health care provider will screen your baby to make sure they are developing normally.
When to Call Your Health Care Provider
Call your baby’s health care provider if they:
- have worse signs of withdrawal
- are not eating
- have diarrhea or vomiting
- cannot be calmed down
When to Call 911
Call 911 for emergency help if your baby:
- has a seizure
- turns blue
- stops breathing
HH-I-320 ©2009, Revised 2021, Nationwide Children’s Hospital