by hannahphn

Hello everyone! I'm new to this forum, so this is my first posting.

I'm a PHN and work with high risk infants. I'm wondering--has anyone had experience with newborns and methadone withdrawal? What are some of the signs/symptoms of methadone withdrawal in newborns?

Thanks for any responses in advance!

Depends on mom's dose, but tremors, poor sleeping, loose stools. Fussy babies, hard to console, can all be part of it. It's a good idea to do Neonatal Abstinence Scoring (Finnegan scale) on the baby. Sometimes we have to start them on methadone, too. Often we start with Phenobarb, and if that doesn't work we go to methadone.

As you're a PHN, the baby must be at home. I would expect a newborn methadone baby to be hospitalized until it's stable. Depending on mom and the extent of her drug use, that could take us 2-3 months.

When I deal with a little drug baby, whose mom *only* uses methadone, I want to take her off it, too. Then she would know why it's screaming.

Originally Posted by Mimi2RN

Depends on mom's dose, but tremors, poor sleeping, loose stools. Fussy babies, hard to console, can all be part of it. It's a good idea to do Neonatal Abstinence Scoring (Finnegan scale) on the baby. Sometimes we have to start them on methadone, too. Often we start with Phenobarb, and if that doesn't work we go to methadone.

As you're a PHN, the baby must be at home. I would expect a newborn methadone baby to be hospitalized until it's stable. Depending on mom and the extent of her drug use, that could take us 2-3 months.

When I deal with a little drug baby, whose mom *only* uses methadone, I want to take her off it, too. Then she would know why it's screaming.

There was a baby in our nursery for the last few days being weaned off the methadone, and today was her first day without it. Some of the other symptoms I saw from her were: wanting to suck constantly, sneezing episodes, 3-4 sneezes at a time, and increased muscle tone. She is eating okay, but she is also eight days old, so she had to work it out.

Threre is a regional methadone clinic in our area so we see our fair share of methadone babies. Just as the others mentioned, we see the same symptoms with the most common ones being very tight muscle tone, irritability, sneezing, loose stools, excoriation to knees or other areas that come in contact with the bedding, high temperatures, and sometimes feeding difficulties. The babies sometimes act very "frantic" at feeding time. It's like they know they are hungry and are trying to eat but the minute the nipple hits their mouth they don't have the patience to latch on and suck at first. We seem to notice that the symptoms begin to appear when they are 2 or 3 days old. Depending on the mother's dosage, the symptoms can last for several days to a few weeks. The longest we had a baby with symptoms was about a month. We do Finnegan scoring every 4 hours and generally give tincture of opium to the babies which helps a lot. Other helpful things are to keep the room quiet, be very attentive to their stirring and cries and then intervene immediately, don't rock them too much and don't talk to them while they are eating. Seems like they get overloaded with stimulation much easier than other babies and this only makes matters much worse. Over time they need less and less medication and usually get to go home after they have been off medication for a few days. We encourage the mom to visit often so she can learn the best ways to care for her baby. We also work very hard at not being judgemental since this does nothing to help the baby or it's family. Granted, these babies can be a real handful when they are in the worst part of their withdrawl, but at least it's better than heroin or whatever...

We have moms that get into a methadone program a couple of weeks before they deliver, so that they can prove that they are trying, and will be able to keep their babies.The babies have already suffered through heroin, sometimes cocaine or metamphetamines, and maybe a little marijuana for relaxation. Now they get methadone to add to the problems. I suppose the good thing is the moms want the babies. To me, it takes special people to adopt these damaged children.

I forgot about the sneezing, and feeding problems, and the horrible diaper rash these little ones get. We have even had to get our Wound nurse to help out with the raw, bleeding butts that we have seen.

What do you think about breast feeding methadone babies?

This going to seem terrible, but I'd rather have a baby withdraw from anything other than methadone.

As far as S/S, if you can get a copy of the abstinence scoring tool (one of your local NICUs would surely give you one), that would give you the whole thing, along with the 'weighting' of each symptom.

Heroin is [IMHO] easier to manage, and babies (other than premies, who tend to have IVH's from almost any drug) seem to get over it, once and for all, a lot sooner. It's pretty awful in any case.

We used the pain service to manage these babies; they'd round, look @ the scores, increase or decrease whatever meds the baby was on. And when the volunteer cuddlers were on, they knew which baby they'd be holding for the 4 hours they were there.

A lot of times, the mom is actually doing both Heroin AND Methadone! No, they're not gonna admit it to you, either. If they ask why the baby is behaving the way it is, be honest. Also, be prepared for them to be sad if CPS takes the baby away from them. Make sure they know why, and mention NOT having another baby until/unless they are clean.

To the OP: What are these kids like in the setting in which you are seeing them in?

Originally Posted by Mimi2RN

I suppose the good thing is the moms want the babies. To me, it takes special people to adopt these damaged children.

What do you think about breast feeding methadone babies?

It would be a better thing if they DID NOT want the baby. It's true, many go on methadone during pregnancy to keep the baby, because they are great manipulaters of the system. I also agree that methadone is far worse than other withdrawals. Screaming, loose stools, tachypnea, sweating, inability to eat.....much rather see a family that is DRUG FREE deal with this stuff than a mom with such poor coping skills that she needs to shoot heroin AND take her methadone. Methadone clinics should REQUIRE birth control...

Oh, those Methadone kids are the worst! I would so much rather have a baby whose mom just did heroin or crystal meth, I know that sounds awful, but it is so true.

We had a kid in our unit a few years ago that had the withdrawls the worst I have ever seen...we ended up having to intubate and totally sedate the kid for over a week( we had him on a Methadone gtt and a versed gtt), every time we let him wake up he totally freaked, puked, ripped the skin off his elbows, knees, etc. The mom told us, "Well, I don't know why he is doing so bad, none of my other 6 kids withdrew like this" What the hell! She had been on meth for YEARS! Surely going clinic to clinic. I agree...they should have to get a depo shot before they get their fix.

These kids do not go home on any narcotics, they have to be totally drug free and under control before they go home. They tend to be crabby kids though, a lot of them have pretty bad reflux too. It is so incredibly sad.

I think methadone is a lot better than moms who use heroin or crack or meth or alcohol. Our unit manages them pretty well with abstinence scoring and appropriate drug therapy. I have seldom seen withdrawal get out of control, except in cases of extreme drug abuse and in cases where the nurse just didn't want to give extra doses of meds based on the abstinence scores. I used to work in Vancouver and heroin use is a HUGE problem. They actually opened an entire unit to deal with pregnant substance abusers because we had so many coming into L&D.

i agree completely, methadone withdrawal is the absolute

worst. it's pretty scary, actually. mehtadone is known to cause the most severe withdrawal in infants. withdrawal from methadone can be have the latest onset too, which is scary for moms taking these kids home when they were doing "fine." our closest methadone clinic is notorious for increasing mom's dosage because she is pregnant. one of our neos AND our perinatologist visited this clinic (an hour away) to plead with them. and yet they are still doing it. it is a horrible problem. seeing one of these babies suffer is one of the worst things i have had to witness in my entire life. so sad.