Understanding Neonatal Abstinence Syndrome
A printable version of this article is available for download at the bottom of this page.
What is Neonatal Abstinence Syndrome
NAS is the abbreviation for Neonatal Abstinence Syndrome. This is a condition caused when a baby withdraws from drugs they are exposed to during birth, these include:
Opiates such as heroin, methadone, buprenorphine and suboxone
Stimulants like amphetamines or cocaine
Antidepressant medicines such as selective serotonin reuptake inhibitors (SSRIs)
Depressants such as barbiturates, or alcohol, or marijuana
Nicotine from cigarette smoking.
Symptoms
The baby has become accustomed to having this drug and at birth this dependence continues. However, the drug is no longer available causing the baby's central nervous system to become overstimulated causing symptoms of withdrawal.
Each baby experiences symptoms differently. Symptoms of withdrawal in full-term babies may include:
Yawning
Stuffy nose, and sneezing
Poor feeding and suck
Vomiting
Diarrhoea
Dehydration
Sweating
Tremors (trembling)
Irritability (excessive crying)
Sleep problems
High-pitched crying
Tight muscle tone
Hyperactive reflexes
Seizures
Diagnosis
It is not possible to predict before birth which babies may develop NAS. The Finnigan Scale is used to diagnose NAS post birth through a points system for signs, symptoms and severity of these. Many NAS symptoms occur within days after birth between 24-48 hours.
Treatment
Specific treatment for NAS will be determined by the babies' doctors and will be based on a variety of considerations. Treatments include:
Medications such as morphine and phenobarbital to treat symptoms such as seizures and to help relieve pain and problems of withdrawals
Swaddling or snugly wrapping of the baby in a blanket may help comfort the baby.
Increased calories because of their increased activity; they may need a higher calorie formula.
Intravenous (IV) fluids are sometimes needed if the baby becomes dehydrated or has severe vomiting of diarrhoea.
Possible Effects of NAS
The problems that children diagnosed with NAS might experience are different for each child and can depend on the drug exposure amount and type.
These effects can include:
Impact on brain structure and functioning
Visual motor integration
Attention: increased prevalence to ADHD
Verbal and short and long-term memory
Learning difficulties and difficulties processing information
Difficulties with reasoning, identifying consequences and problem solving
Internalising and externalising behaviour problems.
There can also be long term effects which can include:
Increased prevalence in heart defects
Challenges with schooling and disrupted school experiences
Drug and alcohol related problems
Mental health issues
High risk activities and behaviours due to impulse control.
Early Intervention
Early intervention and accessing support early is important.
Early childhood is a time of remarkable brain development.
Learning and development is most rapid during the early childhood years.
Future development is based on the child's learning during these early years.
Interventions can be targeted to address the child’s and family’s specific needs. Children often benefit from a combination of therapies – this is called a multidisciplinary approach. Children often need different therapies or therapy combinations at different stages of their development.
The types of therapies include:
Occupational Therapy - to assess motor skills (walking, running and tying shoe laces), sensory processing (how we receive, organise, and understand visual and auditory messages), and visual perceptual skills (making sense of what we see).
Speech Pathology - to assess understanding and use of language, verbal reasoning, and use of speech sounds.
Psychology - to learn how the child's brain works, assessing what the child knows and test their memory capacity.
Links to ADHD and Autism
Children who have been exposed to drugs during pregnancy have a higher risk of possessing symptoms commonly associated with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD) compared to children who were not exposed to opiates or similar substances.
Teaching Strategies
Teaching strategies which could be used for children with a diagnosis of NAS include:
Implementing consistent and predictable routines
Lots of practice
Be really clear about changes
Small steps and breaking down big tasks
Visual cues and aids to accompany instructions
Minimise visual and auditory distractions
Tuition
Educational video games
Enriched spaces
Space for voluntary physical activity.
