Neonatal abstinence syndrome (NAS) is withdrawal your baby can experience after birth when substances they were exposed to in the womb, most often opioids, suddenly stop crossing the placenta. You might notice tremors, high-pitched crying, poor feeding, or sleep trouble. Signs usually appear within 48, 72 hours, though methadone or buprenorphine can delay them up to two weeks. Not every exposed baby withdraws. Care starts with comfort; below, you’ll see how doctors diagnose and treat it.
Key Takeaways
- Neonatal abstinence syndrome (NAS) is withdrawal in newborns after prenatal substance exposure, most commonly opioids, which cross the placenta during pregnancy.
- Not every exposed baby withdraws; neonatal opioid withdrawal syndrome occurs in 55% to 94% of opioid-exposed infants.
- Symptoms include tremors, high-pitched crying, poor feeding, vomiting, loose stools, sweating, and sleep problems; severe cases can cause seizures.
- Signs usually appear within 48, 72 hours, but methadone or buprenorphine exposure can delay onset up to two weeks.
- Treatment begins with supportive care like rooming-in, skin-to-skin contact, and breastfeeding, adding gradually tapered medication if symptoms persist.
What is neonatal abstinence syndrome (NAS)
Neonatal abstinence syndrome (NAS) is withdrawal that a baby can go through after delivery when exposed to certain substances before birth. These substances cross the placenta during pregnancy, and after birth, your baby’s body has to adjust without them. Opioids are the most common cause, and you’ll often hear clinicians use the term neonatal opioid withdrawal syndrome (NOWS) for this specific subset. Other substances can also cause NAS.
You may hear people say a baby is “born dependent,” but that’s an informal phrase. Clinicians describe it as withdrawal after prenatal exposure. Exposure doesn’t guarantee withdrawal. Reported NOWS rates range from 55% to 94% of opioid-exposed infants, and risk and severity depend on the specific type of exposure and other factors.
What causes NAS (opioids, benzos, and other substances)
Opioids cause most cases of NAS, although many substances can cross the placenta. When you use opioids during pregnancy, they pass through the placenta to your baby. After birth, that supply stops suddenly, and your baby’s body can react with withdrawal signs. Clinicians call this specific pattern neonatal opioid withdrawal syndrome (NOWS), a subset of NAS.
Other substances, including benzodiazepines, can also trigger NAS. Your baby’s risk depends on which substances you’ve taken, how long, and other factors.
Exposure doesn’t guarantee withdrawal. Studies report NOWS in 55% to 94% of opioid-exposed infants, and severity varies widely. You may hear the phrase “born dependent,” but that’s informal. Clinically, your baby is experiencing withdrawal after prenatal exposure. It’s a treatable condition, not a reflection of your worth.
What the symptoms of NAS look like in a newborn
NAS symptoms in a newborn include nervous system signs such as tremors, irritability, high-pitched crying, increased muscle tone, and poor sleep. Your baby may also struggle to feed, vomit, have loose stools, or gain weight slowly, risking dehydration. Other signs include sweating, fever or unstable temperature, frequent yawning or sneezing, and a stuffy nose. Severe withdrawal can cause seizures. Symptoms can last days or months.
Your baby’s withdrawal signs may not appear right away, because timing depends on the substance and how you were exposed. Most signs appear within 48, 72 hours after birth, but long-acting opioids, including methadone and buprenorphine, can delay onset up to 2 weeks.
These signs overlap with other newborn conditions, so your care team evaluates the full picture and doesn’t diagnose based on any single symptom.
How NAS is diagnosed and treated in the hospital
Your baby’s care team diagnoses NAS using clinical signs and your medical history, including which substances your baby was exposed to before birth, and treats it with supportive care first, adding medication if symptoms persist. Because withdrawal overlaps with other newborn conditions, clinicians evaluate the full picture, often using standardized scoring or functional assessments. The American Academy of Pediatrics recommends at least 3 days of observation after short-acting opioid exposure and up to 7 days after long-acting opioids, buprenorphine, or methadone.
Supportive care includes rooming-in, skin-to-skin contact, swaddling, a quiet environment, and breastfeeding when appropriate, and you can help with all of these. If symptoms persist, your baby may receive morphine or methadone, which the team tapers gradually rather than stopping abruptly. You’ll learn about delayed symptoms and connect with follow-up care and support services before discharge.
How NAS severity and treatment compare by substance
Withdrawal timing, observation length, and treatment options differ by the substance your baby was exposed to, but severity isn’t determined by the substance alone.
| Exposure | What to expect |
|---|---|
| Short-acting opioids | Signs often appear within 48, 72 hours; at least 3 days of observation |
| Long-acting opioids, buprenorphine, or methadone | Signs can start later, sometimes up to 2 weeks; observation up to 7 days |
Your baby’s care usually begins with soothing, feeding support, and skin-to-skin contact, whatever the substance. If those measures don’t control severe opioid withdrawal, your team may use morphine or methadone, tapering the dose gradually. Some settings also use clonidine, phenobarbital, or buprenorphine. Your team tailors treatment to your baby’s symptoms and overall clinical condition.
Why treatment during pregnancy reduces NAS risk
Treatment during pregnancy doesn’t necessarily lower your baby’s chance of withdrawal. Its value is in helping your baby’s care team recognize and manage withdrawal. If you take methadone or buprenorphine, your baby still has prenatal opioid exposure, and the American Academy of Pediatrics recommends observing these infants for up to 7 days. Withdrawal from long-acting opioids can even begin later, sometimes up to 2 weeks after birth.
Treatment connects you with a care team that knows your exposure history, which helps clinicians interpret your baby’s signs accurately. You can plan ahead for rooming-in, skin-to-skin contact, and breastfeeding when appropriate, since supportive care can begin at birth.
Staying engaged in treatment also prepares you for discharge. You’ll learn which delayed symptoms to watch for and how to reach follow-up care quickly.
How Pathways Recovery supports mothers before and after delivery
Pathways Recovery supports mothers during pregnancy and after delivery, because your baby’s care depends on accurate exposure history and early planning.
Before delivery, you can work with our team to share accurate substance-use and treatment history with your prenatal and pediatric providers. This helps them plan observation: the AAP recommends at least 3 days after short-acting opioid exposure and up to 7 days after methadone, buprenorphine, or long-acting opioids.
After delivery, we can help you prepare for rooming-in, skin-to-skin contact, swaddling, and breastfeeding when clinically appropriate. We’ll help you recognize delayed withdrawal signs, which can appear up to 2 weeks after birth, and connect you with pediatric follow-up, early-intervention services, and community supports. Your recovery and your baby’s care move forward together.
Get Support Before and After Delivery
If you are pregnant and using opioids, getting treatment can help reduce the risks associated with untreated opioid use disorder. Pathways Recovery provides opioid addiction treatment with medically supervised detox, Suboxone-based treatment, and continued recovery care. Your prenatal and pediatric teams can manage pregnancy and newborn care alongside addiction treatment.
Call (916) 735-8377 to discuss opioid treatment and your next step.
Frequently Asked Questions
Can a Mother Breastfeed Her Baby if the Baby Has NAS?
Breastfeeding may be appropriate for some mothers and can be part of supportive care for infants with neonatal opioid withdrawal syndrome. The decision depends on factors such as whether the mother is stable in treatment, whether she is using illicit substances, the medications she is taking, and the baby’s medical condition. Your obstetric and pediatric teams should determine whether breastfeeding is appropriate and provide guidance on feeding and monitoring.
How Long Does a Baby With NAS Usually Stay in the Hospital?
The length of a newborn’s hospital stay depends on the opioid involved, timing of the last exposure, severity of symptoms, feeding and weight gain, and whether medication treatment is needed. Babies exposed to some long-acting opioids may require longer observation than those exposed to short-acting opioids. Hospitals use different observation protocols, so parents should ask the newborn’s care team how long monitoring is expected for their baby’s specific exposure.
What Delayed Withdrawal Signs Should Parents Watch for After Going Home?
Parents may notice irritability, tremors, difficulty feeding, excessive crying, poor sleep, vomiting, diarrhea, or difficulty gaining weight. Symptoms can vary depending on the opioid and timing of exposure. Follow the discharge instructions from your baby’s healthcare team and contact them if feeding, sleep, behavior, or weight gain becomes concerning. Seek emergency care for a seizure, severe breathing problems, or another medical emergency.
Does NAS Cause Long-Term Developmental Problems as the Child Grows?
Prenatal opioid exposure has been associated with potential differences in development, behavior, and learning, but outcomes vary widely and cannot be attributed to neonatal withdrawal alone. Genetics, environment, prenatal care, other substance exposures, and socioeconomic factors can also affect development. Regular pediatric visits and developmental screening can help identify concerns early and connect families with appropriate intervention services.
What Follow-Up Care and Support Services Are Available After Discharge?
Follow-up may include routine pediatric care, developmental screening, early-intervention services, feeding support, and additional monitoring when recommended. Parents should also receive guidance on safe sleep, feeding, weight gain, and signs that require medical attention. If the mother has opioid use disorder, continuing addiction treatment is also important. Ongoing care may include medication treatment, counseling, and recovery support after delivery.