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Neonatal Opioid Withdrawal Syndrome (NOWS)

What Is Neonatal Opioid Withdrawal Syndrome?

Neonatal Opioid Withdrawal Syndrome (NOWS) (also known as neonatal abstinence syndrome, or NAS), develops after a baby is born and no longer gets certain drugs or medicine from the mother. Some examples might be methadone, heroin and Percocet.

Neonatal Opioid Withdrawal Syndrome Symptoms

It is hard to tell which babies might get neonatal opioid withdrawal syndrome. Some babies have NOWS when a mother takes only a small amount of drugs, while other babies may only have NOWS when a mother takes large amounts of drugs. Most babies born to mothers using drugs develop NOWS, and signs are most often seen within the first few days after birth. Some signs of NOWS are:

  • High-pitched cry
  • Tremors, jittering, shaking of arms, legs, face
  • Frequent yawning
  • Hard time sucking during feeding times
  • Poor weight gain
  • Fast breathing
  • Frantic sucking of fists, fingers, thumbs
  • Trouble falling asleep and staying asleep
  • Fussy and hard to calm
  • Sneezing, stuffy nose
  • Tense arms, legs and body
  • Vomiting, diarrhea
  • Skin rashes – more so in the diaper area and face
  • Warm to touch, sweating

Neonatal Opioid Withdrawal Syndrome Treatment

Nurses use a scoring sheet to help them watch for signs of NOWS. This score helps the team know if a baby has NOWS. If a baby has a high score for a while, medicine may help a baby be more comfortable. If a baby does get medicine, the medicine will be lowered over time depending on each baby's needs.

Below are things you can do to help comfort your baby during this time.

Signs of NOWS

Calming Suggestions

Prolonged or high-pitched cry
  • Hold the baby close to your body, skin to skin or lightly wrapped in a blanket. Be careful to not fall asleep while holding your baby.
  • Try gentle rocking, talking, singing and humming.
  • Keep lights turned down and the room quiet.

Trouble falling asleep
  • Turn down the lights, keep the room quiet or pat baby gently.
  • Hold baby skin to skin. Be careful to not fall asleep.
  • Gentle rocking.
  • Check for a clean diaper. Use diaper creams for rashes as needed.
  • Offer breastfeeding or a bottle whenever your baby is hungry. This is not the best time to get your baby on a schedule.

Excessive sucking of fists
  • Feed your baby until they are full and calm.
  • Consider a pacifier. If your baby does not want the pacifier, do not force sucking.
  • Think about using mittens if the skin is damaged.
  • Keep skin clean and avoid lotions on hands and arms since the baby may suck them.

Difficult or poor feeding
  • Feed your baby small amounts often. You can work on a schedule once the baby is better.
  • Feed your baby in a quiet room with low noises, lights and activities.
  • Allow time for rest in between sucking.
  • Limit family and friends so your baby does not get handled too much.

Fever, sweating
  • Keep clothing light, such as a T-shirt.
  • Avoid heavy clothes. You will want to be able dress your baby and change diapers easily.
  • Use light swaddling and blankets.

Sneezing, stuffy nose or breathing troubles
  • Keep your baby’s nose and mouth clean by using bulb suction. You may use saline drops if needed.
  • Make sure blanket swaddling is not tight since this might make it hard for your baby to breathe easily.

Spitting up

 
  • Make sure to burp your baby each time they stop sucking, as well as at the end of feeding.
  • Keep your baby clean and the bedding free of vomit.
  • Talk to your doctor if your baby has vomited medications.

Trembling, jittering

  • Keep your baby in a warm, quiet room.
  • Avoid a lot of handling. When you do handle your baby, try to avoid any extra movements.
  • Hold your baby to make them feel safe and loved.

Parents can help their baby best by staying nearby and holding their baby. Many parents find their baby calms best when handled gently, slowly and when held close to their body. This is because you and your baby know each other best.

If you are worried or anxious, your baby can pick up your energy. If you find this to be true, try to take deep cleansing breaths and focus on calming yourself.

If you need help, please ask a family member or friend. If you do not have help close to you, call your baby’s doctor.

Can I Breastfeed My Baby?

We know that breastfeeding is best for your baby. If you are on any medicine or drugs, the baby will get small amounts through the breast milk. This is usually safe if the mother’s medicine is managed by her doctor, but check with your baby’s doctor to make sure it is safe for your baby. It is vital that the mother does not take any other medicine while breastfeeding unless your baby’s doctor says the medicines are safe.

When Can I Take My Baby Home?

You can take your baby home when:

  • Your baby no longer needs medicine (if it was started).
  • Your baby is eating well and gaining weight.
  • Your baby can keep a stable heart rate, breathing rate and temperature.
  • You have a community doctor to provide follow-up care for your baby.
  • You know how to calm your baby.
  • You received all needed teaching, including safe sleep practices.

Your baby may have some of these problems after leaving the hospital:

  • Problems feeding
  • Slow weight gain
  • Poor sleeping patterns
  • Sneezing, stuffy nose or trouble breathing

Your baby’s doctor or nurse can help teach you ways to care for your baby. Also, work with your baby’s doctor to find community resources.

Last Updated 10/2024

Reviewed By Amanda Luciano, RN
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The Neonatal Abstinence Syndrome (NAS) Clinic provides developmental screening, occupational and physical therapy, and education about nutrition and feeding for families like Melinda Marcum and her young son, DeMichael.
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