Nonpharmacologic supportive care for 
infants with NAS 

Parents of infants with NAS should be counseled on 
evidence-based, supportive treatments to implement after hospital discharge. Swaddling techniques may help minimize fussiness and agitation, and may be particularly useful during feedings. 

Poor motor control also can contribute to poor feeding. For example, the infant may turn his or her head from side to side vigorously when the nipple or pacifier is brought close to the mouth. Helping to steady the head will be helpful in these instances.12

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Nonpharmacologic supportive care for infants with neonatal abstinence syndrome
  • Decrease environmental stimuli
  • Use tight swaddling; position on side or back in “C” curve
  • Apply pressure over infant’s head and body for calming effects
  • Cluster infant-care activities with gentle handling
  • Encourage non-nutritive sucking
  • Use small, frequent feedings, with hypercaloric formula if needed
  • The baby should be breastfed if possible.
  • Bright lights, excessive noise, and other sensory stimulation should be kept to a minimum. It is essential that the infant be monitored closely for weight gain and for the development of other diseases. 


    As the use of illicit drugs by pregnant women increases, so does the number of infants who develop signs and symptoms of NAS, the prevalence of which is most pronounced in infants exposed to opioids.

    Nonpharmacologic management with supportive measures to ameliorate the infant’s CNS, GI, and autonomic disturbances are the standard of care, regardless of the need for pharmacologic intervention.

    Given the increased medical and developmental risks infants with NAS face, adequate nutrition to meet the increased caloric needs is essential for weight gain and growth. Small, frequent feedings with hypercaloric infant formula given in a low-stimulus environment, alone or as a supplement to breastfeeding, are recommended. 

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