Neonatal Opioid Withdrawal Syndrome (NOWS)

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 8 min read
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Neonatal opioid withdrawal syndrome (NOWS) occurs in newborn babies who have been exposed to opioids during pregnancy. This condition can lead to various symptoms and complications for the baby. Here, we'll break down everything you need to know about NOWS in simple terms. Neonatal opioid...

For severe symptoms, danger signs, pregnancy, child illness, or sudden worsening, seek urgent medical care.

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Article Summary

Neonatal opioid withdrawal syndrome (NOWS) occurs in newborn babies who have been exposed to opioids during pregnancy. This condition can lead to various symptoms and complications for the baby. Here, we'll break down everything you need to know about NOWS in simple terms. Neonatal opioid withdrawal syndrome (NOWS), also known as neonatal abstinence syndrome (NAS), happens when a baby is born addicted to opioids because...

Key Takeaways

  • This article explains Causes of Neonatal Opioid Withdrawal Syndrome (NOWS) in simple medical language.
  • This article explains Symptoms of Neonatal Opioid Withdrawal Syndrome (NOWS) in simple medical language.
  • This article explains Diagnostic Tests for Neonatal Opioid Withdrawal Syndrome (NOWS) in simple medical language.
  • This article explains Non-Pharmacological Treatments for Neonatal Opioid Withdrawal Syndrome (NOWS) in simple medical language.
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Emergency safety firstUrgent warning signs are highlighted below.

Seek urgent medical care if you notice

These warning signs are general safety guidance. Local emergency numbers and clinical judgment should always come first.

  • Severe symptoms, breathing difficulty, fainting, confusion, or rapidly worsening illness.
  • New weakness, severe pain, high fever, or symptoms after a serious injury.
  • Any symptom that feels urgent, unusual, or unsafe for the patient.
1

Emergency now

Use emergency care for severe, sudden, rapidly worsening, or life-threatening symptoms.

2

See a doctor

Book a professional medical evaluation if symptoms persist, worsen, recur often, affect daily activities, or occur in a high-risk patient.

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Use this article to understand possible causes, tests, treatment options, prevention, and questions to ask your clinician.

Neonatal opioid withdrawal syndrome (NOWS) occurs in newborn babies who have been exposed to opioids during pregnancy. This condition can lead to various symptoms and complications for the baby. Here, we’ll break down everything you need to know about NOWS in simple terms.

Neonatal opioid withdrawal syndrome (NOWS), also known as neonatal abstinence syndrome (NAS), happens when a baby is born addicted to opioids because the mother used opioids during pregnancy. It’s like the baby is going through withdrawal, just like an adult would if they suddenly stopped taking opioids.

Types of Neonatal Opioid Withdrawal Syndrome (NOWS)

There’s generally one type of NOWS, but the severity can vary from mild to severe depending on various factors such as the type of opioid used, the amount used, and how long the baby was exposed to the opioids before birth.

Causes of Neonatal Opioid Withdrawal Syndrome (NOWS)

  1. Maternal opioid use during pregnancy (such as heroin, oxycodone, or methadone)
  2. Prescription opioid abuse by the mother
  3. Medical use of opioids during pregnancy for pain management
  4. Using opioids while pregnant without a doctor’s prescription
  5. Previous history of opioid addiction
  6. Lack of access to prenatal care
  7. Smoking or using other substances during pregnancy, which can increase the risk of opioid use
  8. Socioeconomic factors, such as poverty or unstable living conditions, which can contribute to substance abuse during pregnancy
  9. Mental health issues, such as depression or anxiety, which may lead to self-medication with opioids
  10. Lack of education or awareness about the risks of opioid use during pregnancy
  11. Genetics may play a role, as some babies may be more susceptible to NOWS due to their genetic makeup
  12. Concurrent use of other substances, such as alcohol or benzodiazepines, along with opioids during pregnancy
  13. Inadequate support systems for pregnant women struggling with addiction
  14. Stressful life events or trauma during pregnancy
  15. Lack of access to addiction treatment programs
  16. Peer pressure or influence from friends or family members to use opioids
  17. Unemployment or job-related stress
  18. Relationship problems or domestic violence
  19. Homelessness or unstable housing situations
  20. Lack of social support or isolation during pregnancy

Symptoms of Neonatal Opioid Withdrawal Syndrome (NOWS)

  1. Excessive crying or irritability
  2. Poor feeding or sucking reflex
  3. Difficulty sleeping or staying asleep
  4. Tremors or shakes
  5. Fever or sweating
  6. Sneezing or stuffy nose
  7. Diarrhea or vomiting
  8. Rapid breathing or difficulty breathing
  9. Seizures or convulsions (in severe cases)
  10. Hyperactive reflexes or muscle stiffness
  11. Excessive yawning or sneezing
  12. Poor weight gain or failure to thrive
  13. Irritability or fussiness
  14. Excessive sucking on hands or fingers
  15. Skin rash or itching
  16. Excessive sweating or clamminess
  17. High-pitched crying
  18. Problems with temperature regulation (either too hot or too cold)
  19. Frequent hiccups
  20. Difficulty bonding with caregivers

Diagnostic Tests for Neonatal Opioid Withdrawal Syndrome (NOWS)

Diagnosing NOWS involves a combination of medical history, physical examinations, and sometimes laboratory tests. Here are some common diagnostic methods:

  1. Medical History: The doctor will ask the mother about her opioid use during pregnancy and any other substances she may have used.
  2. Physical Examination: The doctor will examine the baby for signs and symptoms of withdrawal, such as tremors, irritability, or poor feeding.
  3. Scoring Systems: Some hospitals use scoring systems, such as the Finnegan Scale, to assess the severity of withdrawal symptoms.
  4. Meconium Testing: Meconium, the baby’s first stool, can be tested for the presence of opioids to confirm exposure during pregnancy.
  5. Urine Toxicology: In some cases, the baby’s urine may be tested for the presence of opioids.
  6. Blood Tests: Blood tests may be done to check for other medical conditions or complications related to NOWS.
  7. Imaging Tests: In rare cases, imaging tests such as MRI or CT scans may be done to rule out other medical conditions.

Non-Pharmacological Treatments for Neonatal Opioid Withdrawal Syndrome (NOWS)

Treating NOWS often involves providing comfort and support to the baby as they go through withdrawal. Here are some non-pharmacological treatments:

  1. Swaddling: Wrapping the baby snugly in a blanket can help them feel secure and calm.
  2. Kangaroo Care: Skin-to-skin contact with the mother or caregiver can help regulate the baby’s temperature and promote bonding.
  3. Gentle Touch: Massaging the baby or gently stroking their skin can provide comfort and soothe their nervous system.
  4. Quiet Environment: Keeping the baby in a quiet, dimly lit room can help reduce stimulation and promote relaxation.
  5. Frequent Feedings: Feeding the baby smaller, more frequent meals can help prevent dehydration and promote weight gain.
  6. Pacifiers: Offering a pacifier can help satisfy the baby’s need to suck and provide comfort.
  7. Environmental Support: Providing a calm, supportive environment for the mother can help reduce stress and improve bonding with the baby.
  8. Support Groups: Joining a support group for mothers with opioid addiction can provide emotional support and practical advice.
  9. Education: Educating parents and caregivers about NOWS and how to care for a baby going through withdrawal can help reduce anxiety and improve outcomes.
  10. Follow-up Care: Ensuring that the baby receives regular check-ups and follow-up care after discharge from the hospital can help monitor their progress and address any ongoing needs.

Drugs Used in the Treatment of Neonatal Opioid Withdrawal Syndrome (NOWS)

In some cases, pharmacological treatments may be necessary to manage severe withdrawal symptoms. Here are some drugs commonly used in the treatment of NOWS:

  1. Morphine
  2. Methadone
  3. Buprenorphine
  4. Clonidine
  5. Phenobarbital
  6. Diazepam (Valium)
  7. Lorazepam (Ativan)
  8. Gabapentin
  9. Tizanidine
  10. Hydroxyzine

Drugs:

  1. Morphine
  2. Methadone
  3. Buprenorphine
  4. Clonidine
  5. Phenobarbital
  6. Diazepam
  7. Lorazepam
  8. Hydroxyzine
  9. Gabapentin
  10. Tizanidine
  11. Paroxetine
  12. Sertraline
  13. Fluoxetine
  14. Naltrexone
  15. Naloxone
  16. Suboxone
  17. Nalbuphine
  18. Oxycodone
  19. Fentanyl
  20. Codeine

Surgeries:

  1. There are no surgeries specifically for treating NOWS, as it is managed primarily through non-pharmacological and pharmacological interventions.

Preventions:

  1. Avoiding opioid use during pregnancy, especially without a doctor’s prescription.
  2. Seeking help for opioid addiction before or during pregnancy.
  3. Educating pregnant women about the risks of opioid use to themselves and their babies.
  4. Providing support and resources for pregnant women struggling with opioid addiction.
  5. Addressing social and economic factors that contribute to opioid use during pregnancy.
  6. Encouraging prenatal care and monitoring for pregnant women with a history of opioid use.
  7. Promoting alternatives to opioids for pain management during pregnancy.
  8. Screening for substance use disorders during prenatal visits.
  9. Offering counseling and support services for pregnant women with substance use disorders.
  10. Ensuring access to addiction treatment programs for pregnant women in need.

When to See Doctors:

If you’re pregnant and using opioids, it’s important to seek medical help as soon as possible. Doctors can provide support and resources to help you quit safely and protect your baby from NOWS. If your baby shows signs of withdrawal after birth, it’s crucial to see a doctor right away for proper diagnosis and treatment. Early intervention can make a big difference in managing NOWS and preventing long-term complications for your baby.

In conclusion, Neonatal Opioid Withdrawal Syndrome (NOWS) is a serious condition that affects babies exposed to opioids during pregnancy. By understanding the causes, symptoms, diagnosis, and treatment options, caregivers can provide the best care and support for babies going through withdrawal. Seeking help from healthcare professionals and support networks is essential for both the baby and the caregiver’s well-being.

 

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. Thank you for giving your valuable time to read the article.

 

Doctor visit helper

Prepare before seeing a doctor

A simple rural-patient checklist to help you explain symptoms clearly, ask better questions, and avoid unsafe self-treatment.

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

  • Write when the problem started and how it changed.
  • Bring old prescriptions, investigation reports, and current medicines.
  • Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
  • Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

  • What is the most likely cause of my symptoms?
  • Which danger signs mean I should go to hospital quickly?
  • Which tests are necessary now, and which can wait?
  • How should I take medicines safely and what side effects should I watch for?
  • When should I come for follow-up?

Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
  • CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
  • Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
  • Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Avoid heavy lifting, sudden bending, and prolonged bed rest.
  • Use comfortable posture and gentle movement as tolerated.
  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Medicine doctor / pediatrician for children / qualified clinician
Tests to discuss with doctor
  • Temperature chart and hydration assessment
  • CBC with platelet count if fever persists or dengue/other infection is possible
  • Urine test, malaria/dengue tests, chest evaluation, or blood culture only when clinically indicated
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
  • Do I need antibiotics, or is this more likely viral?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Neonatal Opioid Withdrawal Syndrome (NOWS)

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

RX Patient Help

Ask a health question safely

Write your symptom story. A health professional or site editor can review it before any answer is prepared. This box is not for emergency care.

Emergency first: Severe chest pain, breathing trouble, unconsciousness, stroke signs, severe injury, heavy bleeding, or rapidly worsening symptoms need urgent local medical care now.

Frequently Asked Questions

Is this article a replacement for a doctor?

No. It is educational content only. Patients should consult a qualified clinician for diagnosis and treatment.

When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.

References

Add references, clinical guidelines, textbooks, journal articles, or trusted medical sources here. You can edit this area from the RX Article Professional Blocks panel.

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