When I was told that my daughter had been exposed to drugs in utero, I wasn’t sure what to expect. It can be difficult to find information online about both withdrawal from, and long-term affects of, prenatal exposure. I’m sharing our story today in the hopes of helping some of you prepare.
1. When a child goes through withdrawal, it’s called Neonatal Abstinence Syndrome (NAS).
Withdrawal can start as late as five days postpartum, and last weeks or months.
2. Not every child exposed to drugs or alcohol in utero is going to go through withdrawal, and not all babies who go through withdrawal will need medication in the hospital to get through the detoxification period.
Once the baby is born, they’re assessed using Finnegan Scoring (other scoring systems exist, but Finnegan is the most widely used). This is a process where scores are assigned to various symptoms of withdrawal. Some symptoms include hypertonia (tight muscles), high-pitched cries, inability to sleep, frequent sneezing, diarrhea, tremors, and yawning. With the Finnegan system, the baby is assessed every 4 hours. If there’s a score of at least eight (out of 21) in three consecutive scoring sessions, medication will be started to aid them in the withdrawal process.
3. The weaning period will take time.
Depending on the drug(s) the child was exposed to, and the hospital preference, there are different medications that can be used. Each has a minimum number of days used. For example, my daughter used Buprenorphine. This has a minimum of 8 days, and we were told only 10% of babies finish the process in 8 days. Nurses continue to do scoring every 4 hours. When scores stay under 8 for a given period of time, the next process in weaning can occur. If the scores go above 8 for a given period of time, the baby must go a step backwards in the weaning process (this is why many babies take longer than the minimum stay; finishing in 8 days means no backward steps occur).
I was lucky enough to be able to stay with a friend during my daughter’s time in the NICU, because our particular NICU did not have private rooms. Instead, it was one big room with about 12 pods. Rounds (when the head doctor and residents would go around and discuss each baby) would happen between 7-8 in the morning. I was allowed to be present for rounds if no other parents were there. Otherwise, I had to step outside the room and someone would get me when it was time to discuss my daughter’s case.
4. Skin-to-skin contact is very important during withdrawal.
Some nurses would suggest it, and other times I would have to ask for a screen around our pod so that I could do skin-to-skin. However, it’s also vital for babies with NAS to be in an environment that is as low-stimulation as possible. Meaning, it’s best when the lights are dimmed, unnecessary sensors are turned off, and they’re not disturbed when they are sleeping. This allows the brain to rest and heal. If my daughter was sleeping, I wasn’t allowed to touch her. We kept a thin blanket over her bassinet to dim the light. Nurses used beanbags on top of her to calm her muscles so that she could sleep.
5. Feeding issues are also very common.
It was hard to get my daughter to latch on to the bottle. After we went home, she would scream through feeds. It took a couple months to finally get her diagnosed with a lack of the suck-swallow-breathe reflex. Paced feeding helped teach her how to swallow appropriately.
6. Because withdrawal can cause babies to claw at their faces, I suggest using little mittens.
That was one of those baby products I thought was stupid in the past, but it was really helpful in the NICU.
7. Make sure you take a break for yourself every day.
I forced myself to leave for meals, so that I had 2-3 times a day where I could get some fresh air, check in with my husband and other kids, and eat.
8. Withdrawal is often not finished when your child is discharged from the hospital.
Be prepared for all the same issues from the hospital, just on a smaller scale. Therapy can be very helpful with this. We did physical therapy for a few months to help our daughter with her hypertonia, feeding clinic to teach her how to eat, and later on, some occupational therapy to help her with sensory issues. Your child may qualify for birth to 3 early intervention, which has a different name in each state, but is free and provides in-home services for kids with developmental delays or who are deemed at risk for having developmental delays. While many children with NAS catch up to their peers within the first 1-2 years, it’s common for there to be struggles with ADD/ADHD and sensory integration that are lifelong.
9. There may also be undisclosed alcohol use.
It’s important to note that in cases of poly-drug exposure (meaning, more than one drug was used during pregnancy), there is a high rate of alcohol also being used, even if the birth mother does not disclose this information. Alcohol exposure can lead to a diagnosis of Fetal Alcohol Syndrome.
For more information, I suggest reading the books of Ira J. Chasnoff, MD and research papers by Lynn T. Singer, PhD. I’ve found both of them to be quite informative.