Neonatal Opioid Withdrawal Syndrome (NOWS)
Answers to questions families often have about caring for their child with Neonatal Opioid Withdrawal Syndrome (NOWS)
What is 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.
What can cause 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.
Signs and symptoms of NOWS
- 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
How can I care for my baby with NOWS?
- 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.
Resources
Information & Support
Related Portal Content
Neonatal Opioid Withdrawal Syndrome (NOWS)
Assessment and management information for the primary care
clinician caring for the child with Neonatal Opioid Withdrawal Syndrome (NOWS).
Care Notebook
Medical information in one place with fillable templates to help
both families and providers. Choose only the pages needed to keep track of the
current health care summary, care team, care plan, health coverage, expenses,
scheduling, and legal documents. Available in English and
Spanish.
For Parents and Patients
Comprehensive Addiction Recovery Act (CARA)Caring for a Baby Exposed to Drugs During Pregnancy (NMDOH) (

Helpful Articles
Patrick SW, Barfield WD, Poindexter BB.
Neonatal Opioid Withdrawal Syndrome.
Pediatrics.
2020;146(5).
PubMed abstract
This policy statement by the American Academy of Pediatrics (AAP)'s Committee on Fetus and Newborn and Committee on Substance
Use and Prevention provides an overview of the effect of the opioid crisis on the mother-infant dyad and provide recommendations
for management of the infant with opioid exposure, including clinical presentation, assessment, treatment, and discharge.
Authors & Reviewers
Author: | Medical Home Team |
Page Bibliography
Patrick SW, Barfield WD, Poindexter BB.
Neonatal Opioid Withdrawal Syndrome.
Pediatrics.
2020;146(5).
PubMed abstract
This policy statement by the American Academy of Pediatrics (AAP)'s Committee on Fetus and Newborn and Committee on Substance
Use and Prevention provides an overview of the effect of the opioid crisis on the mother-infant dyad and provide recommendations
for management of the infant with opioid exposure, including clinical presentation, assessment, treatment, and discharge.