Newborn Withdrawal Symptoms (NAS): How Maternal Substance Use Affects Babies and Treatment Options

What newborn withdrawal is (and what it is not)

Newborn withdrawal is a group of symptoms that can happen after birth when a baby adjusts to life without a drug they were exposed to before delivery. The medical name is neonatal abstinence syndrome (NAS). When the exposure is opioids, some teams also use the term neonatal opioid withdrawal syndrome (NOWS).

You may see harsh search terms like “baby addict” or “drug baby.” A newborn is not addicted. Addiction involves cravings and loss of control. A newborn cannot seek drugs. What can happen is physical dependence, followed by withdrawal in infants.

NAS is not one symptom. It is a pattern that can affect sleep, feeding, and body control. Some babies have mild signs and improve with basic soothing. Others need close medical care to stay hydrated, gain weight, and avoid serious problems.

The goal of care is simple: help the baby eat, sleep, grow, and stay safe. The CDC explains NAS and NOWS, and why symptoms often start in the first days of life: Neonatal abstinence syndrome (NAS) and neonatal opioid withdrawal syndrome (NOWS).

How maternal substance use can affect a fetus and newborn

Many drugs and some prescribed medicines can cross the placenta. When exposure happens again and again, the baby’s brain and body start to adapt. After birth, the drug level drops quickly. That change can lead to fetal withdrawal symptoms that show up as newborn withdrawal symptoms.

Opioids are the most common cause of neonatal withdrawal syndrome, but they are not the only cause. Babies can also have symptoms after exposure to benzodiazepines, nicotine, and some antidepressants. Exposure to more than one substance can make symptoms stronger and harder to manage.

Substances most linked with neonatal withdrawal

• Opioids, including heroin, fentanyl, and prescription pain medicines
• Medicine used to treat opioid use disorder in pregnancy (newborns may still need watching)
• Benzodiazepines and other sedating medicines
• Nicotine and heavy tobacco exposure
• Stimulants and other drugs that can affect sleep, feeding, and stress responses

Some people use the phrase “fetal drug syndrome.” Clinicians usually use more specific terms, because risks depend on the substance and timing. For example, alcohol exposure can lead to fetal alcohol spectrum disorders, while opioid exposure may lead to neonatal withdrawal.

What raises the risk of NAS

• Regular use late in pregnancy, especially close to delivery
• Higher doses or long-acting opioids
• Using more than one substance, including alcohol or sedatives
• Limited prenatal care or untreated mental health conditions
• Early birth, low birth weight, or medical stress during labor

Getting help during pregnancy and after delivery can reduce harm for both parent and baby. If you need medical support to stop alcohol, opioids, or other drugs safely, Nova offers Austin detox with 24/7 clinical monitoring and step-down planning.

Symptoms of NAS: common signs of newborn withdrawal

Neonatal abstinence syndrome symptoms most often affect the nervous system and the gut. Signs of neonatal abstinence syndrome can start within the first 72 hours, but timing can be later with long-acting drugs. Some babies show symptoms of NAS early. Others appear calm at first and then struggle later in the first week.

Symptoms vary from baby to baby. The same exposure can lead to different outcomes. That is why hospitals watch feeding, sleep, weight, and comfort over time.

Common symptoms of newborn withdrawal

• High-pitched crying, fussiness, or trouble calming down
• Shaking, tremors, or jitteriness
• Tight muscles, stiffness, or frequent startle reflex
• Short sleep, frequent waking, or trouble settling
• Poor feeding, weak suck, or taking very small amounts
• Spitting up, vomiting, or diarrhea
• Sweating, fever, sneezing, or stuffy nose
• Fast breathing or rapid heart rate
• In severe cases, seizures

Families often search for “symptoms of drug exposed babies,” “newborn withdrawal,” or “symptoms of newborn withdrawal.” Clinicians may describe the same pattern as neonatal withdrawal syndrome symptoms, NAS, or NOWS, based on the exposure history.

How doctors diagnose neonatal withdrawal syndrome

Diagnosis starts with two things: what the baby is doing and what the pregnancy exposure was. The care team will do a full exam, watch feeding and sleep, and check vital signs. They may also order tests to rule out other causes of symptoms.

Hospitals may use urine, meconium, or umbilical cord tissue testing to confirm exposure. These tests help explain risk, but they do not predict how hard withdrawal will be. Some exposed babies have few symptoms, while others struggle.

To track symptoms over time, many teams use structured tools. A traditional approach uses a symptom score that is checked at regular intervals. Newer approaches focus on function, such as whether the baby can eat enough, sleep for reasonable periods, and be consoled with typical care.

For a deeper clinical explanation of neonatal abstinence syndrome symptoms, monitoring, and treatment, see the NCBI Bookshelf review: Neonatal Abstinence Syndrome (StatPearls).

For parents, planning matters too. Many families do best with a step-down plan that includes therapy and relapse prevention support. Nova’s intensive outpatient program in Austin can help some people stay connected to care while keeping work and family routines.

Neonatal abstinence syndrome treatment options in the hospital

Neonatal abstinence syndrome treatment usually starts with non-medication care. The goal is to lower stress, support feeding, and prevent weight loss or dehydration. Many babies improve with consistent soothing, skilled feeding support, and a calm environment.

Supportive care that often helps first

• A calm, dim room with less noise and fewer sudden changes
• Swaddling, gentle rocking, and skin-to-skin contact
• Small, frequent feeds and extra burping to reduce spit-up
• Monitoring weight, hydration, temperature, and sleep
• Caregiver coaching, so parents know how to soothe safely

Breastfeeding may help some babies when it is safe and medically advised. The care team will weigh benefits and risks based on the parent’s current substance use and treatment plan. If breastfeeding is not recommended, the team will still support bonding through holding, skin-to-skin contact, and responsive soothing.

When medicines are used

If supportive care is not enough, doctors may use medicine to reduce withdrawal symptoms and then taper slowly. For opioid exposure, hospitals often use an opioid medicine in a controlled way. Other medicines may be added for specific symptoms, depending on the case and the exposure history.

MedlinePlus has a clear overview of common NAS symptoms and typical treatment steps: Neonatal abstinence syndrome.

Questions to ask your newborn care team

• How long do you expect monitoring to last based on the exposure?
• What signs tell you that my baby is improving?
• What can I do during feeds to help my baby take in enough?
• Are there soothing techniques you recommend for our baby’s symptoms?
• What follow-up visits or early supports should we schedule after discharge?

When newborn care is stressful, family support matters. Nova’s Family Program helps loved ones learn healthier communication and practical ways to support recovery at home.

Length of stay varies. Some babies stabilize in a few days, while others need more time, especially with more than one exposure.

After discharge: what recovery can look like at home

Going home is a big transition. Many babies do well once feeding is steady and sleep improves, but follow-up is still important. Pediatric visits help track growth, feeding, and development, and they help families get early support if concerns show up.

Some babies are more sensitive to noise and light for a while. A quiet home, consistent routines, and lots of soothing contact can help. Safe sleep rules still apply, even when a baby is fussy. Put babies on their back to sleep, in their own sleep space, without loose blankets.

Simple home strategies that can help

• Keep lights low and limit loud sounds during feeds and bedtime
• Offer smaller feeds more often if your baby tires easily
• Swaddle safely and use gentle motion to calm your baby
• Take shifts with another trusted adult so you can sleep
• Write down questions for the next checkup so nothing is missed

Signs your baby may need a call to the doctor

• Feeding gets worse or the baby refuses several feeds in a row
• Persistent vomiting or frequent watery stools
• Fewer wet diapers than usual
• Fever, breathing trouble, or unusual sleepiness
• New or worsening shaking, stiffening, or seizure-like movements

Caregivers also need care. If you are parenting during recovery, stress and sleep loss can raise relapse risk. Family routines, support, and treatment follow-through can make the newborn period safer for everyone.

Nova’s Austin residential inpatient rehab can be a next step when outpatient care is not enough and a stable setting is needed.

Treating the parent supports the baby’s long-term health

Newborn withdrawal is treated in the hospital, but the baby’s long-term health is shaped at home. A steady, safe, sober environment supports bonding, routines, and follow-up care. That is why treatment for the parent is part of the baby’s story too.

If you are pregnant or postpartum, do not stop opioids, benzodiazepines, or alcohol suddenly without medical care. Withdrawal can be dangerous, and trying to quit alone often leads to relapse. A safer plan is medical help, therapy, and steady support.

Practical steps if you are pregnant and worried about substance use

• Tell your prenatal provider what you are using, even if you feel embarrassed
• Ask about safe treatment options during pregnancy, including medication when it is right
• Make a delivery plan that includes newborn monitoring for possible neonatal withdrawal
• Plan for support after birth, including sleep help, meals, and rides
• Set up follow-up care for both you and the baby before you leave the hospital

Some people need a higher level of care to break the cycle of use, stabilize mental health symptoms, and build relapse prevention skills. Nova offers Wimberley inpatient rehab for adults who need immersive, structured treatment in a supportive setting.

If you are worried about neonatal withdrawal or you feel stuck in substance use, you deserve help without judgment. Reaching out early can protect your health and your baby’s future.