Skip to Content

Neonatal Abstinence Syndrome

AMBULATORY CARE:

Neonatal abstinence syndrome (NAS)

develops when a baby is no longer exposed to a drug his or her mother used during pregnancy. Examples include heroin, codeine, and oxycodone. The baby is affected by the drug while in the womb and becomes dependent on it. When the baby is born, he or she is still dependent on the drug. He or she may also become dependent on medicines given for sedation or pain after he or she is born. The sudden lack of the drug causes withdrawal symptoms.

Signs and symptoms of NAS

depend on the amount and kind of drug involved. The following may begin when your baby is born, or several days later:

  • Irritability or high-pitched crying that cannot be consoled
  • Diarrhea or vomiting
  • Trouble feeding, constant sucking, or poor weight gain
  • Tremors in his or her arms or legs, or making his or her muscles rigid
  • Sleeping problems
  • A fever, trouble keeping his or her temperature stable, or sweating
  • Yawning often, fast breathing, or breathing problems
  • Sneezing or a stuffy nose with flaring of the nostrils
  • Fast heartbeat
  • Seizures
  • Mottling (areas of skin that change color) or skin breakdown from rubbing constantly against clothing

Call your local emergency number (911 in the US) for any of the following:

  • Your baby is not breathing or is having trouble breathing.
  • Your baby's skin or nails are blue.
  • Your baby is limp and does not respond.

Seek care immediately if:

  • Your baby stops breathing for short periods of time.

Call your baby's doctor if:

  • Your baby is fussy or cries for long periods and cannot be comforted.
  • Your baby breastfeeds less often or drinks less formula than usual or has feeding problems.
  • You have questions or concerns about your baby's condition or care.

Treatment:

Your baby may need to stay in the hospital for up to a week after birth. He or she may not have symptoms at first.

  • Close and quick attention may help comfort your baby as he or she goes through withdrawal. Healthcare providers may recommend that your baby's mother stay in the room with him or her. He or she may need to be held often or close to someone's chest. Skin-to-skin contact (kangaroo care) may be recommended whenever possible. Healthcare providers will be careful not to wake your baby unless it is necessary. They may swaddle him or her (wrap your baby snugly in a blanket) to help him or her feel comforted and secure. His or her room may be kept dim and quiet to prevent him or her from becoming irritable. Soft music, massage, and rocking can also help comfort him or her.
  • Extra calories may be needed. Your baby may be given formula that is thickened or has a high number of calories. He or she may be able to breastfeed if his or her mother is not taking any drugs or medicines that can be passed through breast milk. He or she may need to be fed small amounts often during the day to prevent vomiting.
  • Medicines may be needed if other methods do not work or if your baby develops serious medical problems. Your baby may be given a medicine that is close to the drug that he or she became addicted to before being born. The amount may need to be increased at first to manage your baby's symptoms. It will be reduced over time so he or she gets used to being without the drug. This may take weeks or months.

Ask about safe ways to comfort your baby:

Some babies are calmed by movement. Others need to be kept still and quiet. Find out what calms your baby. Your baby may cry for long periods without stopping. This can be frustrating, but never shake a baby to make him or her stop crying. Shaking can cause serious brain damage. The following may help you safely comfort your baby:

  • Ask healthcare providers what they did to calm your baby. Talk with them before you take your baby home from the hospital.
  • Put your baby in a safe place if you need a break. Ask a family member or friend to hold your baby. If no one can help, gently place your baby in his or her crib and leave the room for 5 or 10 minutes. Then go back to your baby and try to comfort him or her again.
  • Use a light blanket to swaddle (wrap) your baby snugly. Your baby's healthcare provider can show you how to swaddle him or her if you do not know how. Do not wrap your baby too tightly.
    Swaddle Your Baby
  • Block out noises that may bother or wake your baby. When your baby is trying to go to sleep, play soft music, or sing softly. A fan or humidifier can create a low steady noise that he or she may also find comforting. Dim the lights in the room if your baby is bothered by the light.
  • Try movement to calm your baby. Try putting your baby in an automatic swing or sitting with him or her in a rocking chair. Never shake your baby. You may cause brain damage if you shake him or her.

Follow up with your baby's doctor within 48 hours, or as directed:

You will need to bring your baby in for follow-up visits often at first. Your baby's healthcare provider will check that he or she is eating and sleeping well. Your child will need ongoing care and tests as he or she gets older. His or her healthcare provider will check for developmental or physical delays or problems. Write down your questions so you remember to ask them during your visits.

© Copyright IBM Corporation 2021 Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or IBM Watson Health

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Neonatal Abstinence Syndrome (Ambulatory Care)

Associated drugs

IBM Watson Micromedex

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.