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Many medicines or drugs used by mothers can reach the baby while they are in the womb. Once the baby is born, the baby no longer receives the drug from their mother’s body, and the baby may experience withdrawal. This is called Neonatal Abstinence Syndrome (NAS), or Neonatal Opioid Withdrawal Syndrome (NOWS).
There are many medicines or drugs that can cause NAS but some of the most common are:
Opioids: methadone, buprenorphine (Buprenex® and Suboxone®), morphine, oxycodone (OxyContin® and Percocet®), oxymorphone, hydromorphone (Dilaudid®), hydrocodone (Norco® and Vicodin®), codeine and fentanyl (Duragesic®), heroin
Benzodiazepines: lorazepam (Ativan ®), diazepam (Valium ®)
Other drugs: cocaine, ecstasy, methamphetamine.
We cannot predict which babies will have NAS. The amount of drugs or medicines that the baby receives in the womb does not always match the symptoms that each baby can have after they are born.
Most babies begin to have symptoms of withdrawal between 2 to 4 days after their birth. However, some infants may have them earlier and others may not have them until later. These symptoms may be mild and go away quickly or may continue for months. It is difficult to predict how a baby will be affected by the type of medicine or drug used, when the drug was last used, and if there are multiple drugs used at the same time.
Babies at risk of NAS will have their urine and first bowel movements (called meconium) sent to the lab for drug testing. It is important to tell your health care provider about any medicines or drugs used during your pregnancy. This will help them deliver the best care to you and your baby, give the right medicines if needed, and discharge your baby home as soon as safely possible after birth. Your health care team will share the results of any testing done and will also help you understand signs of withdrawal and how to care for your baby.
Some common withdrawal symptoms you may see in your baby are:
You are the most important person for your baby. Having your baby close to you, cuddling, providing skin-to-skin time, feeding and caring for your baby in a calm environment have been shown to help babies who show symptoms of withdrawal. Being near your baby as much as possible will help you to get to know your baby and how best to comfort your baby. Your health care team is here to support you.
All babies eat, sleep, and need some kind of consoling throughout the day and night. Some babies with NAS need extra help.
The eat, sleep, console method looks at:
During your hospital stay, your health care team will teach you how to recognize expected newborn behaviors as well as signs of newborn withdrawal. Together with your health care team, you will help determine how well your baby is eating, sleeping, and how easily they can be consoled. The nurses will collaborate with you every 3-4 hours to look at your baby’s overall health and will develop a plan of care designed specifically for your baby. You will be given a Newborn Care Diary to help you keep track of how frequently your baby is eating, how long your baby sleeps, and how easily they can be consoled.
Remember, you are the best treatment for your baby and your participation is very important. If you are unable to stay with your baby throughout the hospitalization, you can designate family and friends that are able to help comfort your infant. While we do have volunteers who can help some, they are not available 24/7.
A few ways to comfort a baby that is experiencing withdrawal symptoms can include:
Every situation is different. While it will be safe for most babies to breastfeed, your health care team and lactation consultants can help to determine if breastfeeding is safe for your baby. Breast milk is best for your baby. We strongly support breastfeeding and will do everything possible to achieve your feeding goals. If you have been told that you can breastfeed your baby safely, it is important to know that stopping breastfeeding suddenly may increase your baby's withdrawal symptoms. Before you stop, you should discuss with your doctor how to safely wean your baby from breastfeeding.
Feed your baby when they show signs they are hungry. Feed your baby at least every 4 hours (usually every 2-3 hours) until they are back to birthweight.
Spend as much time “skin to skin” with your baby when you are awake. This helps your baby eat and sleep better and will help calm your baby. It can also help decrease other symptoms of withdrawal and help your milk supply if breastfeeding.
Hold your baby or swaddle your baby in a light blanket. Just being close to someone helps your baby feel safe and comfortable.
Loud noises and bright lights may upset your baby. Help to keep the room calm and quiet with the lights down low. Wear headphones if you want to watch TV/videos. Limit how much you use your cell phone and keep it on silent.
Your baby may want to suck on a pacifier or clean finger, even after a good feeding. Always make sure your baby is not hungry first.
Try to have only one or two visitors in your room at a time to help maintain a calm, quiet environment.
Please tell us if you need support to care for your baby for a bit to help you rest.
Keep your baby in the crib when he or she is not being held. Do not lay your baby on the bed and walk away. Even newborns can fall.
Nationally, there have been reports of accidents involving babies falling to the floor in the hospital when parents fall asleep while feeding or holding their babies. There have also been incidents where a baby has almost been smothered by a sleeping parent.
You may be motivated to hold your baby at all times, but you will get tired. Reach out to your support person(s) or hospital staff to help care for your baby so you can get the rest you need to recover.
Do not sleep with your baby while relaxing in bed, on a couch or in a chair.
If your baby is able to eat, sleep, and be consoled easily, they will likely not need medication and will stay in the hospital for about 5 days for close observation. If your baby is having difficulty eating, sleeping, and is difficult to console due to withdrawal symptoms, they may need medication to help them through withdrawal. Together, you and your care team will decide if medication is needed to ease the symptoms. If medication is needed, your infant will be monitored in the Special Care Nursery or Neonatal Intensive Care Unit.
Some babies need a few doses of medicine while others may need medicine for 10 to 14 days. Occasionally, babies need medicine even longer. It is important for you or another family member to stay involved with your baby's care during the entire hospital stay.
Your health care team will continue to assess your baby and decide when your baby is ready to go home. Your baby is ready for home when they:
Once your baby is home, withdrawal symptoms may continue for several weeks. These symptoms, which should be mild when your baby goes home, will gradually decrease. Getting plenty of rest for you and your baby can help to reduce stress for both of you.
A home care nurse visit may be arranged. The nurse will check your baby's symptoms, weigh your baby, review your baby's medications, and answer any questions you may have. The home care nurse can help give you advice about your baby's care and withdrawal as well as many other topics of caring
for your newborn. You know your baby better than anyone does. Trust your instincts. Talk to your baby's home care nurse or contact your health care provider anytime you feel something is not right.
If your baby received medication to help with their withdrawal symptoms while in the hospital, they will be referred to early intervention services through the state and the Intensive Care Follow-Up Clinic through Children’s Minnesota. You should expect a phone call from early intervention (Help Me Grow or Birth to 3) to set up an evaluation and from the Intensive Care Follow-up Clinic to set up an appointment. The goal of these services is to help your baby reach their developmental milestones on time.
It is important to choose a primary care provider and/or a clinic where you will bring your baby for appointments. You will be asked to make an appointment for your baby before they go home from the hospital. This appointment and all follow up appointments are very important to keep so that your baby remains healthy. It is also a good time for you to be able to ask questions. If your baby is on medications to prevent withdrawal, you will need to take your baby to the clinic every 7-10 days. At the clinic, staff will:
Pediatric Clinics
Minneapolis clinic: 612-813-6107
St. Paul clinic: 651-220-6700
Breastfeeding Resource Center
Minneapolis: 612-813-6250
St. Paul: 651-220-6368
Children’s Home Care
612-813-6246
This sheet is not specific to your child but provides general information. If you have any questions, please call your clinic.
Reviewed 6/2024
This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Minnesota Family Resource Center library, or visit www.childrensmn.org/educationmaterials.
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