If you're pregnant, your addiction specialist or obstetrician may mention neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome (NOWS). Both of these terms refer to the effects your baby could experience after delivery related to opioid exposure during pregnancy. It's important to understand what signs and symptoms to look for and what to do about them.


NAS and NOWS describe a cluster of symptoms that infants may develop within their first 24 to 48 hours of life if their mothers were using opioids before delivery. They may happen even if the mother uses opioids prescribed by a doctor, including for the treatment for opioid use disorder (OSD). 

Medication for opioid use disorder (MOUD) may include drugs such as buprenorphine and methadone. While these are effective for treatment, they do pose some risks.

Not every mother who uses opioids during pregnancy will have a baby who has symptoms of NAS/NOWS. And not every baby with signs of NAS/NOWS will need enhanced care. 

For some babies, comfort care measures, including skin-to-skin contact and breastfeeding, can go a long way in managing symptoms and may reduce the need for more involved treatment. The treatment plan is something you and your care team will need to evaluate and decide together. If you notice symptoms, talk with your care team about what to do next. 

In more severe cases, babies may need additional monitoring and require medication to help ease symptoms, including small doses of morphine. It's crucial to work with a doctor to give any necessary prescriptions safely.

Symptoms of NAS/NOWS

In most cases, treatment for NAS/NOWS will begin at the hospital. So let hospital staff know about your opioid use, including your treatment for OSD. Since symptoms sometimes can arise after you bring your baby home, continue to monitor your newborn for signs and symptoms if you were using opioids during your pregnancy, even as part of a treatment program for OUD. 

The Centers for Disease Control and Prevention (CDC) lists the following signs and symptoms for NAS/NOWS:

  • Tremors or trembling

  • Irritability, including excessive or high-pitched crying

  • Sleep problems

  • Hyperactive reflexes

  • Seizures

  • Yawning, stuffy nose or sneezing

  • Poor feeding and sucking

  • Vomiting

  • Loose stools and dehydration

  • Increased sweating

If you notice any of these symptoms in your infant, contact your care team immediately.

It can be hard to discern what's "normal" from what is not, especially if you are a first-time mom and aren't used to caring for a newborn. Document any potential signs you notice in a written record you can share with your or your child's care provider and keep an open dialog about your experiences and observations. 

Keeping Things in Perspective

Having a baby who shows signs of NAS/NOWS can trigger a lot of self-blame and guilt. Those feelings are unfortunate and unnecessary. It doesn't mean that you're a bad person or have failed as a mother. 

There are many reasons why an infant may or may not develop symptoms of NAS/NOWS, and not all of them are within your control. They include using cigarettes, genetic predispositions, and length of exposure to opioids. 

If you're taking steps to treat your OSD, you are demonstrating enormous dedication to your baby's well-being. At Confidant Health, we are proud to be in your corner as you work toward success on your recovery journey.