When a baby is exposed to opioids in the womb, they may go through withdrawal after birth. This condition is called Neonatal Opioid Withdrawal Syndrome (NOWS) or Neonatal Abstinence Syndrome (NAS). Caring for a baby with NOWS can be challenging, but with the right support, patience, and information, parents and caregivers can help their baby heal and grow strong.

What Is NOWS?

NOWS happens when a baby who was exposed to opioids before birth suddenly stops receiving them after delivery. Common opioids include prescription painkillers (like oxycodone, hydrocodone, or morphine), heroin, and medications used to treat opioid use disorder (like methadone or buprenorphine, such as Subutex). 

When the baby is born, their body may have to adjust to the absence of the drug. This can lead to withdrawal symptoms, which can range from mild to severe.

What Symptoms Might You See?

Symptoms of NOWS usually start within 1–3 days after birth but can take up to a week. Symptoms may include:¹

• High-pitched crying or fussiness
• Tremors or shaking
• Poor feeding or slow weight gain
• Trouble sleeping
• Vomiting or diarrhea
• Sneezing, yawning, or stuffy nose
• Tight muscles or rigid arms and legs
• Fever or sweating

How Are Babies with NOWS Treated?

Each baby is different. Typically, healthcare providers will look at various symptoms to determine what treatment should be offered, often using a tool called Eat, Sleep, Console (ESC). The tool looks at the infant’s ability to eat more than 1 oz or breastfeed well, sleep for more than an hour, and be consoled.²

Non-medication treatments are the first line of care. These soothing, gentle approaches can reduce the baby’s withdrawal symptoms and improve bonding. If the baby is having trouble eating, sleeping and being consoled, medication like morphine or methadone may be given in small, safe doses and then slowly reduced over time.³

Helpful Tips for Soothing and Supporting Your Baby

Here are ways you can help your baby feel more comfortable:

1. Create a Calm Environment

• Keep lights dim and noise levels low.
• Avoid strong smells or loud TV/radio.
• Speak softly and move slowly around the baby.

2. Hold and Soothe Your Baby Often

• Swaddle your baby gently to help them feel secure.
• Hold them skin-to-skin (also called kangaroo care) as much as possible.
• Rocking, patting, or using a baby swing can help calm them.

3. Feed Your Baby Slowly and Often

• Babies with NOWS may have trouble feeding or staying full.
• Try smaller, more frequent feedings.
• Burp your baby often to avoid gas and spit-up.

If you’re breastfeeding, let your healthcare team know what medications you are taking. Note that breastfeeding is safe for mothers who take methadone or buprenorphine. Breastfeeding may reduce symptoms of NOWS and the length of a hospital stay.⁴

4. Watch for Signs of Overstimulation

• If your baby starts crying more, stiffens up, or turns their head away, they may be overstimulated.
• Give them a break from handling or feeding and help them settle.

5. Create a Safe Sleeping Environment ⁵

It’s important to create a safe place for your baby to sleep using a firm and flat mattress and a tight-fitting sheet with no blankets of extra padding. Other safety measures include:

• Place your baby on their back to sleep, every time. Side or tummy sleeping increases the risk for Sudden Infant Death Syndrome (SIDS). Your baby may move around more as they grow. Once your baby can roll over both ways, it’s okay if they roll onto their tummy during sleep—but always start them on their back.
• Keep the crib or bassinet free of pillows, toys, stuffed animals, blankets of crib bumpers. These items can block a baby’s airway or cause suffocation.
• Dress your baby in one layer more than you’d wear. Consider using a sleep sack or wearable blanket

6. Track Symptoms and Share with Providers

• It can help to keep a notebook of your baby’s symptoms, feedings, diaper changes, and sleep.
• Share this with doctors or nurses so they can adjust care if needed. Also be sure to ask for help if other problems occur such as depression.

Seek help if signs of infant withdrawal become unmanageable or if additional problems occur.

Plan of Safe Care

Families and caregivers of infants treated for Neonatal Abstinence Syndrome (NAS) or other prenatal substance exposures should receive a Plan of Safe Care.⁶ Usually this plan is developed with you while you are in the hospital after birth of your child. This plan is designed to support and strengthen the family and ensure the child’s safety.

Each Plan of Safe Care is tailored to meet the unique needs of the infant, caregiver, and family. It may include referrals to substance use treatment, health care, and developmental support services. The plan also helps identify community agencies that provide these resources and promotes clear communication and coordination among everyone involved in the infant’s care.

Taking Care of Yourself

Caring for a baby with NOWS can be emotionally and physically draining. You may feel overwhelmed, guilty, or anxious. Here are some reminders: 

• Ask for help. Friends, family, and professionals can give you breaks and support. 
• Rest when you can. Even short naps help. 
• Talk to a counselor or support group. You’re not alone. Many parents have been through this. 
• Stay engaged in treatment if you are recovering from substance use. Your recovery is a key part of your baby’s health too.

Getting Help and Resources

You don’t have to do this alone. Here are some resources: 

Pediatrician or Family Doctor: They’ll track your baby’s growth and development. 

Home visiting programs: Nurses or trained staff can visit your home and help with baby care. 

Early intervention services: These can provide therapy or support if your baby has developmental delays. 

Substance use treatment programs: If you’re in recovery, staying connected to care helps you and your baby. 

With loving care and proper medical attention, most babies with NOWS do well over time. Some may need extra help with feeding, sleeping, or development, so regular checkups are important. Building a strong, nurturing bond with your baby—through eye contact, touch, and responsiveness—can make a big difference in their recovery and growth.  

Caring for a baby with NOWS takes time, patience, and compassion. While it can be hard, your love and care are powerful tools in helping your baby feel safe and thrive. Don’t hesitate to reach out for help—support is available, and you and your baby deserve it.

If you ever feel stuck or unsure, reach out to our Baby Steps helpline by texting BABY to 55753.  Our helpline specialists are people who care and want to help—without judgment.