Neonatal Abstinence Syndrome (NAS)

What Is NAS?

If a woman uses drugs (including some types of medicines) during pregnancy, her baby can be born with neonatal abstinence syndrome, or NAS for short.

NAS happens because the baby becomes dependent on the drug during the pregnancy. After delivery, the baby no longer gets the drug from the mom's bloodstream. This causes the baby to go through withdrawal.

One common type of NAS is neonatal opioid withdrawal syndrome (NOWS). This is when a baby has withdrawal specifically from an opioid drug. Opioids (also called narcotics) are drugs prescribed for severe pain. They include morphine, codeine, hydrocodone, oxycodone, meperidine, and fentanyl. The drug heroin is also an opioid, as is methadone, which is used to help people quit using drugs like heroin.

Babies can have NAS or NOWS even when the drugs the mother used were prescribed by a doctor.

What Happens When a Baby Has NAS?

Babies with NAS are sometimes born too early (premature) and often are smaller than other babies. They usually start to show signs of withdrawal a few days after birth. They may be fussy, irritable, or cry a lot, usually with a high-pitched cry. Many babies have trouble sleeping, eating, and gaining weight. They also may:

• shake, tremble, or move in a jerky way
• have stiff arms and legs
• have a big startle reflex
• have a fever and/or sweat a lot
• throw up or have diarrhea
• have trouble breathing
• have blotchy skin
• yawn a lot
• have a stuffy nose or sneeze a lot
• have seizures

Not every baby will have all these symptoms. It depends on what drugs the mother used, how long and how often she used them, and how soon before birth she took them.

How Is a Baby With NAS Treated?

Right after the baby is born, the hospital care team might use the “Eat, Sleep, Console” approach. Every newborn eats, sleeps, and needs consoling (caring and comforting). This approach looks at how the baby is eating and sleeping and whether they can be consoled when fussy or crying. The care team uses this information to decide what treatment would be helpful. This may include swaddling the baby, dimming the lights, and medicines.

The baby’s parents are an important part of the ESC approach. They stay with their baby in the hospital as much as possible and help the care team 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 drug 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 NAS need extra care. Here's what you can do:

Comfort your baby. Keep your baby away from bright lights and loud noises. Always place your baby to sleep on their back. Don't bundle your baby up too much.

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, but avoid patting or stroking.
• 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 drug use, even if they take medicine for withdrawal symptoms. Breastfeeding can help reduce symptoms of withdrawal in the baby. If you feed your baby formula, make sure you give it as directed by your doctor and in the right amounts.

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

What to do if your baby sucks their fists often. Offer a pacifier. Keep your baby's hands clean, but don't apply lotions or creams. Cover your baby's hands with mittens to protect the skin and prevent your baby from scratching their face.

What to do if your baby 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, put your baby in a safe place like a crib or bassinet and go into another room to take a break. Or ask a family member or friend to take over for a while.

Can NAS Be Prevented?

If you're pregnant or thinking about getting pregnant, the best way to prevent NAS is to not use drugs.

If you take drugs and are planning to get pregnant, use birth control during sex until you quit the drug. This will help give you time to get off of any drugs that could harm a baby.

If you take drugs and are pregnant, talk to your health care professional about the best way to stop. Quitting drugs all at once can cause serious problems for you and your growing baby. Your doctor may suggest medication-assisted treatment (MAT) or another method to help you quit.

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.