questions about NAS baby--feeding and meds

bookworm1 · Jun 14, 2007

"neonatal abstinence"...does this mean the baby was born addicted??

If that is the case, then this mom probably should not even consider breastfeeding.

sorry, just a lowly student, so I am probably wrong, but I've had a few of these babies in my home over the years:o so it rubs the wrong way!

SteveNNP, MSN, NP · Jun 14, 2007

I would let baby BF for 15-20 min, and then finish with either PO/OG expressed breastmilk until the kid's "milk drunk" I would also have mom pump at least once after baby's done eating to see how much she's got left, to give an idea of when to pump again. We sometimes use methadone on our NAS kids with pretty good luck, it doesn't mess with their gut like opioids do. Sometimes all you can do is tank them up on milk and wear them out with a warm bath....

Elvish, BSN, DNP, RN, NP · Jun 14, 2007

Our attendings go back & forth about BFing while mom's on methadone. One week it's ok & the next week it's not. Most of our moms weren't planning on BFing anyway so it's rarely an issue.

I have seen a HUGE difference in babies that are on Morphine vs those on methadone. It's like night & day. Give me a methadone babe any day. They do so much better, in my experience. Milk, a warm bath, a soft chest, and a binky are great things for these kiddos.

(Note: I don't do NICU...we wean our methadone babies in well NBN. We send them to NICU if seizing, etc.)

babynurselsa, RN · Jun 14, 2007

You have to be careful about letting them eat them selves silly. These babies only know that their tummy hurts. They cannot tell the difference between " my tummy hurts because I am hungry vs my tummy hurts because I am withdrawing." These babnies will eat insane amounts that in turn causes more tummy ache, and diarhea and a raw excoriated butt. This is only more misery.

Make sure that you are scoring this baby fairly. I have seen many folks that will think they are doing the baby a favor by giving an actively withdrawing baby a better score (lower) so the doc looks at the chart and says "Well this baby is doing well, let's decrease his meds." Then you take a miserable withdrawing infant and just succeeded in making him totally more miserable and can actually throw him into seizures due to decreasing his morphine to rapidly.

These are tough kids to care for. They do not console like a normal baby.

As to letting mom breastfeed? Is she still taking the substance to which baby is withdrawing? THen baby is still getting it, so he won't withdraw untill she weans him. Now remember that this will be at home with her on her own. This kid will be set up for abuse. You think this kid is tough to care for for 12 hours? Try living with it. And if this mom is addicted then yan consider that her coping mechanisms are not optimal. Just something to think about.

Elvish, BSN, DNP, RN, NP · Jun 14, 2007

If I'm in doubt, I always score them higher.

I've heard that BFing makes the withdrawal less acute. I've never had a mom actually BF more than like once before they give it up, so I really can't say for sure. But what is the difference between that and giving/weaning them from methadone for the withdrawal sx? Just a few weeks ago we had a kid that was absolutely the worst child I've ever seen withdrawing while on morphine. We switched him to methadone & it was like night and day, he went home much sooner than he would have had he been on mso4.

My heart goes out to these kids because withdrawal is just the beginning of their lifelong issues. Behavior, emotional, etc.

I have seen a big difference in moms who are on methadone for pain vs for heroin addiction. Most who are on it for pain would rather not be but it is the only thing that works. That has been my experience.

dawngloves, BSN, RN · Jun 14, 2007

These kids will eat 'til they puke and suck mom raw. I agree that letting him bf for 15 minutes q 3 until mom's milk comes in and then bttle feed. Mom should pump afterward. We do q 6 NAS too, regardless of age, unless the baby gets a rescue dose.Then we'll document 1 hour after that to see if it was theraputic.

lovemyjob · Jun 15, 2007

our docs said that in the bf/milk/drug book (think i is redd, cant recall name) that street drugs are not a contraindication b/c the benefit outweighs the risks. not totally sure i agree, but.....

dawngloves, BSN, RN · Jun 15, 2007

I belive you mean the Hale book. I agree with the benefit/risk take. We let moms on MSo4, percocet, breast feed, why not methadone?

prmenrs, RN · Jun 15, 2007

I'm not so sure about breast feeding on methodone--can't always know for sure if that's all mom is taking. If that is the decision, I agree w/Dawn re: limit time @ breast, then offer a bottle. You could also give a little formula to "take the edge off" so they won't be so frantic @ the breast. Drug moms feel so guilty, they don't usually stick--to hard to watch the baby's misery. I'd be surprised if one actually breast fed for long.

I agree about the tendency to overfeed--they can wake up every hour or so @ 1st, and easily take 2 ounces. Followed shortly thereafter by a diaperfull. These kids have a very short transit time! Protect your clothing!

You can, if the docs will let you, thicken the feedings w/a small (

We had the pain team see these babies and control their pain meds based on their abstinence scores (which can tend to be rather subjective). The pain team was very helpful for continuity.

Rocker beds and swings, heart beat sounds, pacifiers, volunteer cuddlers, extra strength diaper cream--it takes more than a village to get a baby thru w/drawal.

crazyaaa · Jul 21, 2007

Thx a lot for all the input,really helps!