Neonatal Opioid Withdrawal Syndrome (NOWS) (FAQ)

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

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 overcoming 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

Family Voices
A national, nonprofit, family-led organization promoting quality health care for all children and youth, particularly those with special health care needs. Locate your Family-to-Family Health Information Center by state.

Family Voices (FVAO) or Health Information(F2F) Center
Family-to-Family Health Information Centers are nonprofit, family-staffed organizations that assist families of children and youth with special health care needs (CYSHCN). Locate state-based F2F HICs, providing support, information, resources, and training.

Parent Training and Information Centers (PTI)
Provide training and information to parents of infants, toddlers, children, and youth with disabilities and to people who work with parents to enable them to participate more fully and effectively with professionals in meeting the educational needs of their children with disabilities. See the link for Download a List of Parent Centers across the USA to find the parent center in your state; U.S. Department of Education.

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
This policy statement by the 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

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