Congratulations on your pregnancy or the birth of your new baby!
Neonatal Opioid Withdrawal Syndrome, or NOWS, is a group of signs that show up in babies who have been exposed to opiates during pregnancy. If your baby was exposed to opioids or maintenance therapy for opioid use (also called replacement therapy) during pregnancy, we will provide special care to help your baby through withdrawal from these drugs.
Our goal is to work with you to create a positive experience for you and your baby. Through our Eat-Sleep-Console Program, we support your baby’s healthy development, while improving your parenting confidence and skills, and creating a healthy path forward for the both of you.Our care team has special training and knowledge to support you and your baby through pregnancy, birth and baby’s withdrawal. Our experts in pregnancy, substance use disorders, and newborn medicine provide care for you and your baby. Our practices are based in a trauma-informed approach.
Your hospital stay
When you come to the hospital to have your baby, our goal is for you and your baby to stay together in a private room, either in Von Voigtlander Women’s Hospital or C.S. Mott Children’s Hospital.
Babies who need medicine may be in the hospital for about a week, but some babies need to stay in the hospital longer.
You and your baby’s medical team will talk about what your baby needs in order to go home safely. This will include eating, sleeping, and being consoled in addition to other things all babies need.
Your baby’s behavior guide
The information we’re sharing will help you and your baby every day. Using your baby’s behavior as a guide, you will learn what actions to take to calm your baby when they need it most.
Follow these steps to use the table below:
- Observe your baby’s behavior and decide what color zone your baby is in right now (green is most relaxed and comfortable, yellow or red means they need something to be more comfortable).
- In the left column, look for the behaviors you see your baby experiencing.
- In the right column, read the tips to know what you can do to help your baby.
- Being in the green zone means your baby is comfortable.
- The yellow zone means your baby needs some help to be comfortable.
- The red zone means your baby needs lots of help to be comfortable.
- Your baby may be in between zones many times each day.
- When you find something that helps your baby, make a note of it.
- As you get used to understanding your baby’s needs, you will be able to help them stay calm and stay in the green zone more often.
If you see these green zone behaviors in your baby, try one thing at a time to help your baby.
|Baby stays awake and is calm||
|Baby sleeps longer between feedings
Baby doesn’t need to be held to sleep
|Baby may still have some tight muscles||
|Baby may like more activities||
If you see these yellow zone behaviors in your baby, try one thing at a time to help your baby.
|Baby cries and fusses easily
Baby needs help to stay calm
|Baby startles and wakes up easily
Baby needs help to stay asleep
|Baby has some short moments of being awake and calm||
|Baby’s movements are calmer
Baby’s arms and legs are still tight
Baby may arch their back when upset
If you see these red zone behaviors in your baby, try one thing at a time to help your baby.
|Baby is crying and fussing a lot
Baby has a constant, high-pitched cry
Baby is hard to calm down
|Baby is very sensitive to noise||
|Baby has trouble falling asleep||
|Baby’s muscles are tight
Baby’s body is tense
Baby moves in a jittery way
Baby’s arms and legs won’t stop moving
Baby arches their back when upset
Feeding your babyIt’s important to feed your baby when they are hungry, and to stop feeding them when they show you they are done. Here are some ways you can tell when your baby is hungry:
- Your baby will move hands to their mouth, or suck on their fist or fingers.
- If your baby does those things first and then fusses or cries, they are really hungry and need to eat now!
- Your baby will stop sucking or close their mouth.
- They may turn away from the breast or bottle.
Creating a calm environment at homeThere are things you can do to make your home a calm, safe place for your baby. Think about how you can use these tips after you and baby are home together.
- Keep it quiet
- Turn down the volume on the TV or radio.
- Use a quiet voice when talking.
- Keep your phone ringer on a low setting.
- When you play music, play it softly.
- Limit lights and keep them low
- Use natural sunlight when possible.
- Avoid fluorescent lights.
- Avoid toys that light up.
- Your baby should not watch TV or screens.
- Sleep is healing
- Your baby should sleep on their own in a quiet room.
- Do not wake your baby unless it is time to eat.
- Don’t disturb your baby while they are sleeping.
- Keep your baby sleeping on their back.
- Slow, steady moves
- Use slow and gentle movements with your baby.
- Try swaying or rocking side to side or up and down.
- Only use a swing if your baby stays calm in it.
- Swaddle your baby to help them stay calm.
- Stick to a routine
- Your baby does best with regular times for naps and overnight sleeping. Keep them at home as much as possible.
- Limit visitors
- Make sure there aren’t too many people around at first.
- Remind visitors to stay calm and quiet.
- Don’t pass your baby from person to person.
Awake and calm is a good time to playWhen you notice your baby is awake and calm, gently introduce them to a new activity. Try one new activity at a time. If an activity makes your baby upset, stop and do something that calms them. You can try the new activity again later.
Some good activities to try:
- Reading a book.
- Singing softly.
- Gently moving arms and legs.
- Putting them on their tummy to play.
- Playing a quiet game like pat-a-cake.
Add these activities slowly:
- Mobiles with music or lights.
- Toys with lights or sounds.
- Time with more than 1 or 2 other people at once.
- Trips away from the house.
When you should call your baby’s doctorYour baby may have symptoms of withdrawal for up to 6 months after birth. Call your baby’s doctor if these symptoms return or get worse:
- Muscles and movements:
- Muscle tightness
- Startles easily
- Tremors/shaking or jerky muscles
- Extra sucking
- Lots of yawning
- Crying: Constant, high pitched cry
- Sleeping: Sleeping less than 2 hours at a time after eating
- Loose or watery poop
- Explosive diarrhea
- Throwing up
- Stops eating well for more than a few hours
- Stuffy nose
- Lots of sneezing
- Fast breathing
- Sweating or fever
- Skin breakdown or bad diaper rash
Taking good care of yourself is taking good care of your babyHere are some tips to help you take care of yourself:
- Remember that your presence and touch are healing for your baby.
- Make a list of friends and family that can give you positive support.
- Ask friends and family when you need help with your baby’s care.
- Know that it’s normal if you’re having a hard time.
- If you get mad while your baby is crying, put baby in their bed and take a break. Visit Period of Purple Crying for more information on crying.
- Call your doctor if you are feeling sad or down.
- Notice what things are stressful and what things help you relax in a healthy way.
- Practice deep breathing, visualization, or meditation to help manage stress.
- Set a routine that works for you and your baby.
Your baby needs you to be healthy!
- Eat healthy foods and drink lots of water.
- Find some quiet time for yourself every day.
- Get good rest while your baby is sleeping.