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This article provides information about Neonatal Abstinence Syndrome, commonly called NAS.
What is neonatal abstinence syndrome (NAS)?
Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome that some infants experience after birth and that generally follows exposure to an opioid.
Opioids are a broad class of drugs, some are prescribed for medical reasons (such as vicodin) and others are considered “illicit” (such as heroin).
The severity can vary based on several factors, including type of opioid, other exposures, and genetics.
The syndrome is characterized by tremors, high-pitched crying, loose stools, vomiting, poor feeding, uncoordinated suck, sleep disturbance, seizures, and irritability.
Mild clinical signs, such as irritability, may persist for several months.
Long-term consequences such as learning difficulties may also occur; however, the severity of such consequences remains an area of debate.
How common is NAS?
The Substance Abuse Mental Health Services Administration reported that in 2016, more than 20,000 pregnant women reported using heroin or misusing pain relievers in the past month.
What are some common characteristics of children who have had NAS?
There are no consistent characteristics among children who experience NAS. Researchers have had difficulty separating the effects of the drugs from other environmental effects.
Who might be on the treatment team for a child with NAS?
Immediately after birth, a child with NAS might be cared for in the newborn nursery or in the Neonatal ICU.
After leaving the hospital, their care team might include:
Pediatrician/primary care provider in the medical home.
Early intervention professional.
Developmental-behavioral pediatrician or follow-up team.
Child welfare professionals might monitor the safety of the child, whether the child is in parental care or guardianship care.
What adaptations or modifications may be needed?
Medications
Medications are sometimes used to treat withdrawal symptoms during the acute phase, after birth, but are rarely continued by the time the infant is in out-of-home care.
Dietary Considerations
Dietary adaptations are usually not needed; however, during the acute phase of NAS, infants may have increased suck but poor coordination of swallow and may require high-calorie feedings. Breastfeeding is allowed if the mother is in treatment without relapse.
Physical Environment and Other Considerations
Avoid overstimulation. A quiet, soothing atmosphere might be beneficial.
What should be considered an emergency?
No emergencies are associated with infants who have had NAS, unless they are not identified during the birth hospitalization and withdrawal occurs at home.
What types of training or policies are advised?
Staff should have a nonjudgmental approach to families. Trauma-informed care training might be helpful in understanding and supporting families raising children who have had prenatal substance exposure.
Resources
March of Dimes: “Neonatal Abstinence Syndrome”, www.marchofdimes.org/complications/neonatal-abstinence-syndrome-(nas).aspx
Source: Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide.
Products are mentioned for informational purposes only. Inclusion in this publication does not imply endorsement by the American Academy of Pediatrics.
Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.
This publication was adapted from information from American Academy of Pediatrics Patient Education materials.
Reviewed by: AM M.D., CPCMG Newborn Committee, AR D.O. | 05/2024