Withdrawal

Imafloat, BSN, RN · Feb 17, 2008

What is he withdrawing from. We have had babies take 10-12 weeks to withdraw. Our docs prescribe them methadone, gradually weaning the dose until they are on no methadone. Sweetease doesn't go into their stomach, they aren't drinking it, it gets absorbed into their mucous membranes. With withdrawl kids, I make sure to bundle them well, I place a frog snug on each side of their torso so they feel tight and secure, like they are being held. They are jittery, and have a lot of movement, being wrapped keeps them from moving a lot and waking themselves. We also try to put them in isolation rooms, or quiet parts of the unit, the less stimulation the best.

grlgid · Feb 17, 2008

If they are stable a swing or a vibrating bouncy seat is a wonderful thing but don't forget the all important pacifier, please don't forget the pacifier. They all seem to have that hyperactive suck and get really upset when that "binkie" in not present, even sound a sleep they will suck on that thing.

tina

SteveNNP, MSN, NP · Feb 18, 2008

Or a bath sometimes wears them out to the point of sleeping for a few hours....

kitty29 · Feb 18, 2008

What is he withdrawing from. We have had babies take 10-12 weeks to withdraw. Our docs prescribe them methadone, gradually weaning the dose until they are on no methadone. Sweetease doesn't go into their stomach, they aren't drinking it, it gets absorbed into their mucous membranes. With withdrawl kids, I make sure to bundle them well, I place a frog snug on each side of their torso so they feel tight and secure, like they are being held. They are jittery, and have a lot of movement, being wrapped keeps them from moving a lot and waking themselves. We also try to put them in isolation rooms, or quiet parts of the unit, the less stimulation the best.

I thought sweetease if given too much caused loose stools?

Mom was taking high doses of methadone throughout this pregnacy. Today they did give more phenobarbital and it has helped lessen the morphine dosages...but I just gave one now --- but it's less. Since we are full the consultant had us put the baby in an isolette set very low and covered --- he so far gets too hot if wrapped even before the isolette thing.

Can these babys go into siezures?

kitty29 · Feb 18, 2008

If they are stable a swing or a vibrating bouncy seat is a wonderful thing but don't forget the all important pacifier, please don't forget the pacifier. They all seem to have that hyperactive suck and get really upset when that "binkie" in not present, even sound a sleep they will suck on that thing.
tina

I know the bouncy seat wouldn't work right now as he can barely handle being held! In our unit a baby has to pass a car seat trial before any type of seat or swing is used.

The first night he wouldn't even take a pacie; and only part of the time last night - but better tonight.

kitty29 · Feb 18, 2008

Or a bath sometimes wears them out to the point of sleeping for a few hours....

I thought about a bath - but he was so unsettled I didn't. Now the day nurse did today but it took over an hour as the little guy was so bad and touchy.

kitty29 · Feb 18, 2008

I have responded individually - but want to thank you all for your advice and suggestions. I also talked to our developmental specialist today and she had the same suggestions regarding a quiet area or private room....and the positioning of the baby for comfort to follow those protocols of developmental care.

The doctor had told the parents he thought things would be better in a week and I thought that might be overly optomistic...poor little tyke!

Elvish, BSN, DNP, RN, NP · Feb 18, 2008

To answer your question, I have seen babies seize while withdrawing. It wasn't tremors; it was a tonic-clonic seizure. Horrible.

Our facility rarely weans them with methadone, almost always w/ morphine. I wish they'd switch. Scores are so much lower with methadone weans.

Dark, quiet, swaddling, the paci tucked in under the blankets if you can manage it. Sometimes even just a thick quilt/blanket thrown over the head of the crib helps filter out so much.

Also, is baby constipated? So many of our kids get constipated 'cause the morphine slows their gut down...so on top of withdrawing, their tummies hurt. A good poop and some of them are good to go for a few hours.

My sympathies to you. Withdrawing babies are so miserable, and it can be emotionally draining when NOTHING works.

kitty29 · Feb 18, 2008

To answer your question, I have seen babies seize while withdrawing. It wasn't tremors; it was a tonic-clonic seizure. Horrible.
Our facility rarely weans them with methadone, almost always w/ morphine. I wish they'd switch. Scores are so much lower with methadone weans.
Dark, quiet, swaddling, the paci tucked in under the blankets if you can manage it. Sometimes even just a thick quilt/blanket thrown over the head of the crib helps filter out so much.
Also, is baby constipated? So many of our kids get constipated 'cause the morphine slows their gut down...so on top of withdrawing, their tummies hurt. A good poop and some of them are good to go for a few hours.
My sympathies to you. Withdrawing babies are so miserable, and it can be emotionally draining when NOTHING works.

Thanks!

Can one use methadone if that is what caused the problem...or do you have to use another narcatic? (I really know nothing about this). And YES with the constipation - we have had to give gly. supp. to get a stool...and we are feeding now gastric tube feedings close to full calories by morning. Tummy is soft with gd b.sounds...but I was thinking of suggesting another gly. supp. - and now I've had to repeat the MS04 twice since I've first written tonight.....I tell you that quiet covered Isolette is the thing that is I think really helping him! I feel bad that I didn't do that last night! I thought of it at about 12 noon (when I should have been sleeping).

I wonder what the longer term effects of this will be for this baby too...or if more of an eval will be done before discharge - perhaps close monitoring insted?

SteveNNP, MSN, NP · Feb 19, 2008

I would bet that methadone would be a MUCH better weaning plan for this kid. Methadone is pretty long-acting and heavy duty, especially when you've been swimming in it for 9 mos. We're able to feed/perform cares pretty well while they're on MD. It's a long wean, but sometimes they can go home on it if mom can administer.

Elvish, BSN, DNP, RN, NP · Feb 19, 2008

You're right Steve. It's a longer wean with Methadone, but they do SO MUCH better. I don't understand why they want kids to suffer for 8-12 weeks on MSO4 rather than have a peaceful albeit longer time weaning off Methadone.