Neonatal Abstinence Syndrome: Causes, Symptoms, and Treatment
Written by Achuta Uppu, MD. Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Neonatal Abstinence Syndrome?
A neonatologist, a doctor who cares for newborns who need extra help, usually leads hospital care for this condition. A pediatrician, a doctor for babies and children, follows the baby after discharge. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is neonatal abstinence syndrome?
Neonatal abstinence syndrome (NAS) is a group of problems. It can happen when a baby is exposed to opioid drugs or medicine in the mother's womb for a length of time. Opioids are strong pain drugs. After birth, the baby no longer gets the drug. Withdrawal symptoms may occur as the drug is slowly cleared from the baby's system.
Neonatal opioid withdrawal syndrome (NOWS) is closely related. The CDC says NOWS is a subset of NAS and is specific to opioid withdrawal during the first 28 days of life.
Symptoms
Symptoms often begin within 1 to 3 days after birth. They may take up to a week to appear. Symptoms may include:
- Excessive crying or high-pitched crying.
- Irritability and sleep problems.
- Trembling (tremors) and seizures.
- Hyperactive reflexes and increased muscle tone.
- Poor feeding, excessive sucking, vomiting, and diarrhea.
- Slow weight gain.
- Fever and sweating.
- Fast breathing.
- Stuffy nose and sneezing.
- Blotchy skin coloring (mottling).
Causes and who gets it
NAS may occur when a pregnant woman takes drugs such as heroin, or medicines such as codeine, oxycodone, methadone, or buprenorphine. These substances pass through the placenta, the organ that connects the baby to its mother in the womb. The baby becomes dependent on the drug along with the mother.
If the mother continues to use the drugs within the week or so before delivery, the baby will be dependent on the drug at birth. Withdrawal symptoms also may occur in babies exposed to alcohol, benzodiazepines, barbiturates, and certain antidepressants called SSRIs.
If you are pregnant and take medicines or drugs not prescribed to you, talk to your provider about the safest plan. Some medicines should not be stopped without medical supervision, or complications may develop.
How doctors diagnose it
Many other conditions can produce the same symptoms as NAS. To help make a diagnosis, the health care provider will ask the mother which drugs she took during pregnancy and when she last took them. Her urine may be screened for drugs as well.
Tests for the newborn may include:
- An NAS scoring system, which assigns points based on each symptom and how severe it is. The score can help decide treatment.
- An ESC (eat, sleep, console) evaluation.
- A drug screen of urine and of the first bowel movements (meconium). A small piece of the umbilical cord may also be used.
Treatment
Treatment depends on the drug involved and the infant's overall health and scores. It also depends on whether the baby was born full-term or early. The health care team watches the newborn closely for up to a week, or longer. They look for signs of withdrawal, feeding problems, and weight gain. Babies who vomit or are very dehydrated may need fluids through a vein (IV).
Care without medicine comes first. Ways to calm babies include:
- Gently rocking the child.
- Reducing noise and lights.
- Skin to skin contact with mom, or swaddling the baby in a blanket.
Some babies with severe symptoms need medicines such as methadone or morphine. The dose is slowly lowered once the signs of withdrawal are controlled. These babies may need to stay in the hospital for weeks or months after birth. Treatment can last from 1 week to 6 months.
When to see a doctor
Make sure your provider knows about all the medicines, supplements, and drugs you take during pregnancy. Contact your baby's provider if your baby has symptoms of NAS. Even after treatment ends and babies go home, they may need extra tender loving care for weeks or months.
Call 911 or go to the emergency room if a baby has a seizure, bluish or grey skin, trouble breathing, is hard to wake up, is unconscious, or has bleeding that will not stop.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Such a doctor can help with follow-up after the baby leaves the hospital and can help coordinate care with specialists.
Common questions
Does treatment help babies with neonatal abstinence syndrome?
Yes, treatment helps relieve the symptoms of withdrawal. Calming care comes first. Some babies with severe symptoms also need medicine.
How long does a baby with NAS stay in the hospital?
Most babies need to stay for observation and monitoring for up to a week. Babies treated with medicine may need to stay for weeks or months after birth.
Can a mother breastfeed a baby with NAS?
Often yes. Breastfeeding is encouraged in general for babies with NAS. It is not recommended if the mother is using illicit drugs, is using more than one drug, or is HIV positive.
Which drugs can cause NAS?
Opioids such as heroin, codeine, oxycodone, methadone, and buprenorphine can cause it. Withdrawal symptoms also may occur with alcohol, benzodiazepines, barbiturates, and certain antidepressants called SSRIs.
Sources
- MedlinePlus - Neonatal abstinence syndrome
- Centers for Disease Control and Prevention - Treat and Manage Infants Affected by Prenatal Opioid Exposure
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
