Signs of neonatal abstinence syndrome (NAS)

Close-up of baby shaking feet while lying down

Many babies exposed to certain substances in the womb (especially opioids) will show some signs of withdrawal after birth since they are no longer exposed to those substances once their umbilical cord is cut and their bodies process those substances out of their system. Withdrawal signs may include:

Tremors (jitteriness or shaking of the extremities) Trouble sleeping (falling asleep and staying asleep)
Overactive reflexes (twitching movements) Breathing problems (fast breathing)
Tight muscle tone (stiffness) Elevated body temperature (fever, sweating, blotchy skin)
Fussiness (excessive crying or having a high-pitched cry) Excessively rooting with trouble sucking
Poor feeding (unable to eat enough, vomiting) Lots of yawning
Slow weight gain (burning too many calories, poor feeding, diarrhea, vomiting) Stuffy nose and/or lots of sneezing

Seizures (convulsions) are the most severe sign of withdrawal, but luckily is a very rare occurrence.  Signs of NAS may range from mild to moderate, to severe.  Not every baby will show the same signs. Even within the same family, siblings can have different symptoms and different severity of symptoms; this is likely related to different genes a baby inherits from their parents. Other factors that may affect the expression and/or severity of signs of withdrawal include gestational age at birth (premature babies are less likely to show severe withdrawal signs), prenatal exposure to certain substances, like tobacco/nicotine, a certain antidepressant (selective serotonin reuptake inhibitors) and anxiety medicines (benzodiazepines) [often increase the severity of withdrawal signs], other medications such as Neurontin/Gabapentin (increase the severity of withdrawal signs), certain herbal products such as Kratom (increase severity), and other illicit substances (often increase the severity of withdrawal signs).

Most withdrawal signs will occur within the first 3 days after birth, but some may be seen right after birth (especially if a mother tries to decrease or stops using a substance in the days leading prior to delivery).  Withdrawal signs can last up to 6 months of age. It is recommended to ask the medical team to explain which withdrawal signs your baby is showing and things you should watch out for. If your baby has trouble eating or sleeping, is crying more than expected, or has loose stools after discharge they should be promptly seen by their doctor.

A photograph of Mark Cody Smith

M. Cody Smith, MD is a board-certified Pediatrician and Neonatologist with clinical, research, and quality improvement expertise in the area of Neonatal Abstinence Syndrome.

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