Neonatal Opioid Withdrawal Syndrome (NOWS)

What Is NOWS?

Neonatal opioid withdrawal syndrome (NOWS) happens when someone uses opioid (OH-pee-oyd) medicines or drugs during pregnancy. NOWS happens because the baby becomes dependent on the drug during the pregnancy. After delivery, the baby no longer gets the opioids from the mom's bloodstream. This causes the baby to go through withdrawal. 

What Are Opioids?

Opioids are a class of drugs that relieve pain and can give a sense of well-being. But they carry a serious risk of addiction and overdose.

Opioids include:

• Prescription medicines used for pain, such as morphine, codeine, hydrocodone, oxycodone, meperidine, and fentanyl. 
• Prescription medicines used to treat substance use disorder, such as methadone and buprenorphine.
• Street drugs such as heroin.

What Are the Signs & Symptoms of NOWS?

A baby with NOWS might:

• be cranky and cry a lot (often a high-pitched cry)
• have trouble sleeping and yawn a lot
• shake, tremble, or move in a jerky way
• have stiff arms and legs
• have a big startle reflex
• have seizures
• have trouble eating
• not gain weight as expected
• have a fever and/or sweat a lot
• have blotchy skin
• vomit (throw up) or have diarrhea
• breathe very quickly
• have a stuffy nose or sneeze a lot

How Is a Baby With NOWS Treated?

After the baby is born, the medical team might monitor the baby for several days in the hospital for signs and symptoms of NOWS. During this time, the baby’s parents are an important part of the care team. They stay with their baby in the hospital as much as possible and help keep track of how their newborn is eating and sleeping, and how easily the baby is consoled.

Parents are encouraged to feed their baby and to hold and cuddle the baby during crying episodes. When the family is closely involved in newborn care, the baby often needs less medicine and can go home from the hospital sooner.

Some babies may need small amounts of a medicine that is like the opioid they were exposed to during pregnancy. As time goes on, they will get smaller and smaller amounts until they can stop getting it without having withdrawal symptoms.

How Can I Help My Baby?

Babies born with NOWS need extra care. Here’s what you can do:

Comfort your baby. Dim lights and a quiet environment can help soothe your baby. Always place your baby to sleep on their back. Avoid bundling your baby too much. Usually one layer more than what you are comfortable in is great for a baby.

Other ways to comfort your baby:

• Use skin-to-skin contact (putting baby bare-chested on your chest) or hold the baby close to your body.
• Gently rock and cuddle your baby often.
• Swaddle your baby and give a pacifier.
• Play soothing music, hum, or sing softly.

Feed your baby when they're hungry in a calm, quiet place. Feeding can take a lot of your baby's energy, so allow time for resting during a feeding.

Talk to the doctor about the best way to feed your baby. Breastfeeding is generally safe for mothers who are in a treatment program for substance use disorder, even if they take medicine such as methadone or buprenorphine. If you feed your baby formula, mix according to the directions on the can or as directed by your doctor.

Change your baby’s diaper after a feeding and keep the diaper area clean and dry.

If your baby:

• Sucks their fists often: Try offering a pacifier. Keep your baby's hands clean, but don't apply lotions or creams. You can also try covering your baby's hands with mittens or socks to protect the skin and prevent your baby from scratching their face.
• Has a runny or stuffy nose: Wipe mucus away with a clean cloth. To help your baby breathe better when awake, hold your baby upright and support the chest with your hand.

Never shake your baby. If you feel overwhelmed, it’s OK put your baby in a safe place like a crib or bassinet, even if the baby is crying, and go into another room to take a break for a few minutes. Or ask a family member or friend to take over for a while.

What Else Should I Know?

With your care and help from the care team, your baby can recover. If you or your partner are struggling with addiction, one of the most important ways to help your baby is to start or continue a treatment program. You don’t have to do this alone. Doctors, social workers, and counselors can help you get the support you need. You can also call SAMHSA's National Helpline at 1-800-662-HELP (4357) for free and confidential help.