Answers to questions families often have about caring for their child with Neonatal Opioid Withdrawal Syndrome (NOWS)

Neonatal Opioid Withdrawal Syndrome (NOWS) occurs in newborns whose mothers took opioid medications or illicit opioids some time while pregnant. During pregnancy, most substances taken by the mother will pass through the placenta and into the baby’s blood stream. This exposes the baby to whatever chemicals are found in drugs and medications. After birth, the baby is suddenly cut off from those medications or drugs and this can cause withdrawal symptoms.

Some babies exposed to opioids before birth will experience withdrawal while others will not and the severity of symptoms may vary. The type and severity of symptoms may be affected by

• exposure to other drugs/substances (like cigarettes or alcohol)
• the duration, degree, timing, and type of opioid exposure
• the mother’s and infant’s metabolism
• other unknown factors

This page will help you learn about NOWS and provide you with some tips on how to console a baby experiencing symptoms of NOWS.

Prescription Medications*

• Morphine
• Oxycontin
• Methadone
• Tylenol with Codeine (Tylenol #3, #4, and #5)
• Subutex
• Hydromorphone
• Fentanyl
• Hydrocodone/Lortab/Norco
• Oxycodone/Percocet

Other Harmful Drugs

• Heroin
• “Oxys”
• Marijuana
• Tobacco

Exposure during pregnancy to the following may worsen symptoms of NOWS

• Cocaine
• Crack
• Ecstasy
• Speed
• Amphetamines
• Methamphetamines
• Alcohol
• Cigarettes/nicotine

*Talk with your doctor if you are on a medication and you are pregnant or planning on becoming pregnant.

• Central nervous system irritability
• High-pitched, continuous crying
• Decreased sleep
• Tremors
• Increased muscle tone
• Hyperactive Moro reflex
• Seizures
• Gastrointestinal dysfunction
• Feeding difficulties
• Vomiting
• Loose or watery stools
• Autonomic nervous system activation
• Sweating
• Fever
• Frequent yawning and sneezing
• Increased respiratory rate
• Nasal stuffiness and flaring

• Work closely with your baby’s nurses and doctors to understand what to expect and to learn what works best for your baby
• Keep your baby in a dimly lit room
• Keep the room your baby is in quiet—turn off the TV, silence phones, avoid other loud noises
• Gently touch your baby and speak in a low voice
• Cuddle your baby with skin-to-skin contact
• Swaddle your baby in her blanket
• Soothe your baby by holding in an upright position and rocking with smooth motions. You can also gently rub your baby’s back, but don’t pat his back.
• Only wake your baby for feeding
• Minimize visitors
• Give your baby a pacifier
• Never shake your baby. If you feel frustrated, lay your baby down safely in her crib and take a short break.

Based on information provided by the New Mexico Department of Health, Children’s Medical Services.