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Neonatal Opioid Withdrawal Syndrome (NOWS)

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Introduction

The Questions and Answers that follow aim to provide an introduction to Neonatal Opioid Withdrawal Syndrome (NOWS) for parents and other family members. Following those, we offer links to selected resources for more information and support and a list of valuable services.
Note that we use the term doctor to refer to physicians, nurse practitioners, physician assistants, and other licensed clinicians who may care for your child.
More information about many topics relevant to children with NOWS and many other chronic conditions and their families can be found in the left menu.

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

Where can I go for further information?

For Parents and Patients

Caring for a Baby Exposed to Drugs During Pregnancy (NMDOH) (PDF Document 258 KB)
Brochure for parents and other caregivers of infants exposed to drugs during pregnancy. Provides an overview of neonatal abstinence syndrome (NAS, also referred to as NOWS or neonatal opioid withdrawal syndrome), what causes it, and tips on how to console your baby; New Mexico Department of Health.

Caring for a Baby Exposed to Drugs During Pregnancy (NMDOH) (Spanish) (PDF Document 257 KB)
Brochure in Spanish for parents and other caregivers of infants exposed to drugs during pregnancy. Provides an overview of neonatal abstinence syndrome (NAS, also referred to as NOWS or neonatal opioid withdrawal syndrome), what causes it, and tips on how to console your baby; New Mexico Department of Health.

Maternal-Infant Health and Opioid Use (AAP)
Provides resources and information about maternal opioid use and NOWS, including vercoming negative social attitudes and stigma towards pregnant and parenting women with opioid use disorder; American Academy of Pediatrics.

Neonatal Opioid Withdrawal Syndrome: What Families Need to Know (healthychildren.org)
Information about NOWS signs, symptoms, breastfeeding, going home, and follow-up care; from the American Academy of Pediatrics.

Families Affected by Parental Substance Use (AAP)
This article reviews some of the short-term effects of maternal substance use during pregnancy and long-term implications of fetal exposure, describes typical symptoms of children and adolescents in families affected by substance use, and provides guidance for treatment; American Academy of Pediatrics

Prenatal Substance Abuse: Short- and Long-term Effects on the Exposed Fetus (AAP)
This report will provides information about the pediatrician’s role in addressing prenatal substance exposure, including prevention, identification of exposure, recognition of medical issues for the exposed newborn infant, protection of the infant, and follow-up of the exposed infant; American Academy of Pediatrics.

Substance Use Screening, Brief Intervention, and Referral to Treatment (AAP)
Policy statement from the American Academy of Pediatrics to describe the concepts and terminology of screening, brief intervention, and referral to treatment, and to offer clinical guidance about available substance use screening tools and intervention procedures.

Helpful Articles

Patrick SW, Barfield WD, Poindexter BB.
Neonatal Opioid Withdrawal Syndrome.
Pediatrics. 2020;146(5). PubMed abstract

Authors & Reviewers

Initial publication: November 2020
Current Authors and Reviewers:
Author: Medical Home Team