Neonatal Abstinence Syndrome: What Parents Need to Know

What is neonatal abstinence syndrome?

During pregnancy, many substances cross the placenta. When a baby has been regularly exposed to a substance and that exposure stops at birth, the baby's body can react with withdrawal signs. When those signs follow opioid exposure, many clinicians now use the term neonatal opioid withdrawal syndrome, or NOWS. NAS is the broader, older term that families still hear most often.

Exposure can come from many sources, including prescribed pain medicine, illicit opioids such as heroin or fentanyl, and medications for opioid use disorder such as methadone or buprenorphine. Other substances, including some sedatives, nicotine and alcohol, can also affect newborns. You can read more about how withdrawal works in the body in our separate guide.

How common is it?

According to the Centers for Disease Control and Prevention (CDC), about 7 newborns were diagnosed with NAS or NOWS for every 1,000 newborn hospital stays in the United States in 2020. That means roughly one baby diagnosed every 24 minutes. Rates rose sharply during the opioid crisis and vary widely from state to state.

Signs care teams watch for

Signs usually appear within the first few days after birth, though timing depends on the substance involved. Signs after short-acting opioids may show up within a day, while signs after longer-acting medicines may appear later in the first week. This is why hospitals often keep exposed babies for several days of observation.

Common signs described by the March of Dimes and the National Library of Medicine include:

• Excessive or high-pitched crying that is hard to soothe
• Trembling, jitteriness or tight muscle tone
• Trouble sleeping or very short sleep periods
• Poor feeding, weak sucking or slow weight gain
• Vomiting, loose stools or dehydration
• Sneezing, stuffy nose, yawning or sweating
• Fast breathing or a fever

Not every exposed baby develops NAS, and signs range from mild to severe. Only your baby's care team can assess what is happening and decide on care. If you notice any of these signs after going home, contact your pediatrician promptly.

How babies with NAS are cared for

Care has changed a great deal in recent years. Many hospitals now use a family-centered approach often called Eat, Sleep, Console. Instead of focusing mainly on scoring symptoms, the team asks simple questions: Is the baby eating well? Sleeping well? Able to be comforted? Parents are treated as a key part of the care team.

Comfort care comes first

Non-medicine care is usually the first step and can make a real difference. The American Academy of Pediatrics and other expert groups describe approaches such as:

1. Rooming in, so the baby stays with a parent instead of in a separate nursery
2. Skin-to-skin contact and frequent holding
3. Swaddling and gentle, rhythmic movement
4. A quiet, dimly lit room with fewer interruptions
5. Small, frequent feedings when the baby shows hunger cues
6. Breastfeeding when the care team agrees it is safe for that family

When medicine is needed

Some babies need medicine to ease withdrawal safely. When that happens, the medical team chooses the medicine, watches the baby closely and adjusts care over time. Decisions about medicine are made by the baby's clinicians based on that baby's needs, and parents can always ask questions about the plan.

Hospital stays for babies with NAS can be longer than a typical newborn stay. Studies of Eat, Sleep, Console programs have found that many babies can go home sooner when comfort care and parent involvement are emphasized.

Pregnancy, recovery and medication for opioid use disorder

If you are pregnant and using opioids, please do not stop suddenly on your own. The American College of Obstetricians and Gynecologists (ACOG) notes that stopping opioids abruptly during pregnancy can carry serious risks for both parent and baby, including relapse and overdose. Talk to a healthcare provider as early as you can.

Medication for opioid use disorder, such as methadone or buprenorphine, is recommended by ACOG and SAMHSA as a standard of care during pregnancy. Babies exposed to these medicines may still develop NAS, but treatment is linked with better prenatal care, more stable health for the parent and lower overdose risk. Our guides on methadone vs. Suboxone and Suboxone treatment explain these options in plain language.

Questions to ask your care team

• Will my baby need extra observation after birth, and for how long?
• Can my baby room in with me?
• Is breastfeeding a safe option for us?
• Who will be part of our care team after we go home?
• What signs should make me call the pediatrician?

What is known about the long-term outlook

Many parents worry most about the future. Research on long-term outcomes is still developing, and it is hard to separate the effects of exposure from other factors such as poverty, stress, premature birth and access to services. The National Institute on Drug Abuse (NIDA) supports ongoing studies, including the large HEALthy Brain and Child Development Study, to answer these questions.

What experts consistently point to is the power of a stable, nurturing home. Regular pediatric checkups, early intervention services when needed, and a parent who is supported in their own recovery all help children thrive.

Support that can help as your child grows

• Well-child visits and developmental screenings
• Early intervention programs for infants and toddlers
• Home visiting programs for new parents
• Parenting groups, peer support and recovery communities

Moving past stigma and finding support

Shame keeps many pregnant people from seeking care. Yet every major medical group agrees that substance use disorder is a treatable health condition and that compassionate care leads to better outcomes for parents and babies. You deserve respect and support, not judgment.

Recovery after birth can bring new stresses: lack of sleep, a baby who is hard to soothe, and changing hormones. Planning ahead for these moments helps. Our guides on relapse triggers and building an early recovery routine offer practical ideas, and partners and relatives may find how to help someone with addiction useful.

If you need treatment, FindTreatment.gov lets you search for programs, including those that serve pregnant and parenting people. The free, confidential SAMHSA National Helpline at 1-800-662-4357 is available 24/7. You can also see our resources page for more help options.

Frequently asked questions