The care your baby may need

The aims of this page are to:

• Help you to understand and recognise neonatal withdrawal symptoms

• Suggest ways to care for your baby during this time.

• Provide advice about the facts, encouragement and support to you, your partner and others to feel reassured and confident about caring for your baby.

What is Neonatal Abstinence Syndrome – NAS?

Opiate medication (including buprenorphine, codeine, heroin, methadone) taken by a mother during pregnancy can cause physical dependency affecting the baby. When the umbilical cord has been cut after delivery of the baby, the supply of opiates to the baby suddenly stops, and the baby may develop physical symptoms known as Neonatal Abstinence Syndrome (NAS). This withdrawal process and effects are similar to that experienced by an adult who suddenly stops taking opiate drugs or medication.

Could my baby be affected?

Some babies exposed to opiate drugs/medication during pregnancy experience some symptoms after birth. The baby may only show signs of mild withdrawal, requiring no more than the usual care given to all babies. However, there are some babies who may have more severe withdrawal symptoms affecting behaviour, feeding and sleeping. These babies may require more specialised care, and may need medical treatment to help them as they withdraw (as an adult would during a planned detox). Each baby is an individual so there is no reliable way of predicting the severity of withdrawal symptoms your baby may experience.

Research suggests that babies who are exposed to multiple drugs during pregnancy are likely to be at increased risk of NAS. During pregnancy it is important to access support and attend antenatal care. Treatment and monitoring of the mother will help to reduce the risks of NAS and improve the health and well-being of both mother and baby.

What will happen after birth?

We will always aim to keep you and your baby together on the postnatal ward. Babies are only admitted to the Special Care Baby Unit (SCBU) if they need medication and further monitoring for NAS. Breastfeeding is encouraged, and will encourage bonding with you baby. The use of some drugs may mean that breastfeeding is not recommended; your midwife or obstetrician can advise you. Most babies do not need treatment for NAS, and will be able to go home after a period of observation. Babies are observed for a minimum of 3 days but some may need a longer period. Withdrawal symptoms may not be apparent immediately after delivery and may develop over a few days or even weeks. Midwifery and Neonatal staff will always explain and discuss with you any treatment your baby may need.

What are the signs and symptoms of NAS?

  • A continuous high-pitched cry
  • Fast breathing (tachypnoea)
  • Irritability, restlessness and scratching of their faces
  • Shaking (tremor) of arms and legs whether disturbed or resting
  • Increased muscle tone where the limbs feel very stiff
  • Feeding difficulties – coordination of sucking and swallowing; frantic sucking
  • Excessive wakefulness – not settling or sleeping after a feed
  • Sickness / vomiting
  • Diarrhea
  • Fever
  • Sweating
  • Excessive sneezing, yawning, hiccups
  • Less commonly fits (convulsions)

Neonatal Nurses on the ward will monitor your baby for any signs of NAS using a withdrawal chart. Scoring for symptoms takes place approximately every 4 hours, depending on your baby’s feeding pattern and behaviour. Severe withdrawal symptoms will require treatment, and your baby will need to be admitted to SCBU. Some babies can still experience withdrawal after they have been discharged from hospital. You can contact your midwife, health visitor or GP if you have any concerns.

Never give your baby any drugs or medication that has not been specifically prescribed for your baby by your GP or the hospital.

What can I do to help my baby?

There are things that you can do which will help your baby to withdraw safely and comfortably:

• Provide a quiet environment with dimmed lighting to reduce the stimulation around your baby. Turning down loud music/TV/voices will help baby to settle if they are crying, irritable or unable to sleep.

• Cuddle your baby as much as possible with skin-to-skin contact as this will help calm your baby, may decrease crying, and help with feeding.

• Handle your baby very gently to help reduce irritability and crying. Gentle baby massage and bathing can be soothing. Discourage visitors from picking up your baby once he/she are settled.

• Dress your baby in cool clothing and change frequently if they are sweating. If they are restless and irritable, a cool sheet can be used to swaddle your baby to avoid him/her getting too hot. Slings can also be useful when you are at home.

• Feed your baby regularly – frequent small feeds are usually best. Keep a record of all your baby’s feeds. If your baby has problems with sucking or is vomiting, talk to your midwife or neonatal staff who will be able to help you.

• Dummies can also be helpful to settle your baby if he/she is excessively sucking.  Do talk to your midwife or neonatal staff about introducing a dummy if you are breastfeeding.

• Change your baby’s nappy regularly. Your baby’s bottom may get sore due to loose stools/diarrhoea. More frequent nappy changes may be necessary and nappy creams are helpful to protect your baby’s skin.

• If your baby sneezes, they may have a blocked nose. Gently wipe the nose if it is dirty but do not clean with cotton wool buds as this can damage your baby’s nose.

• Everyone must avoid smoking cigarettes or illicit drugs around your baby and you must keep your baby out of smoky areas. Make sure that your home, car and other places your baby spends time are smoke free.

Babies on the Special Care Baby Unit (SCBU)

If your baby is admitted to SCBU, you will be actively encouraged to be involved in all aspects of your baby’s care. You will be given a SCBU Parent Guide which will provide you with information about the unit. There is an open visiting policy for parents. Once your baby has been admitted to SCBU, he/she will start medication to help them withdraw safely and to keep them comfortable. Whilst your baby is receiving medication, they will have an apnoea monitor. The nurses will continue to observe your baby using a scoring chart. Sometimes, babies require adjustment of medication dose in order to control their withdrawal symptoms. As your baby’s condition improves, the dose of medication will be gradually reduced. Once your baby’s medication has been stopped, your baby will need to be observed and off the monitor for a minimum of 24 hours to ensure they are well enough to be discharged home.

What else do I need to know?

Most women who use drugs or prescribed medication have a normal pregnancy, labour and delivery. Many babies who are born experiencing drug withdrawal symptoms will recover fully in time but some may experience longer-term consequences including behavioural issues and developmental problems. Follow up by a Consultant Paediatrician after discharge will be arranged as appropriate. Babies who are withdrawing may be demanding to care for and this can be a difficult time for some mothers who may feel guilt or blame. Your community midwife, specialist midwife, neonatal staff, health visitors and community drug/alcohol team are always available to talk to you about any concerns or questions you and your family may have.

Ref: 14/20/53