Opioid-Exposed Children Need Sleep Specialists
Disordered sleep becomes apparent at birth for many newborns with prenatal opioid exposure. The sleep medicine community is uniquely positioned to provide support.
By Andrea Bonhiver
Article Source: https://sleepreviewmag.com/sleep-health/demographics/age/opioid-exposed-children-need-sleep-specialists/
Every day in the United States, more than 59 newborns are diagnosed with neonatal opioid withdrawal syndrome.1 Symptoms—tremors, fever, hypertonia, excessive crying, inconsolability, and problems with breathing, feeding, and sleeping—can begin within 24 to 72 hours after birth. Less known is that these newborns experience absent or disrupted sleep-wake cycles that can persist long after hospital discharge.2
“Little is known about the long-term effects of prenatal opioid exposure on sleep health. However, emerging evidence suggests that prenatally opioid-exposed neonates (POE) can have significant manifestations in pediatric sleep medicine, most specifically insomnia and circadian rhythm disorders,” says Chad Eiken, MBA, RPSGT, CCSH, a board member of Generation O: The National Organization for Opioid-Exposed Children. “History of POE may provide valuable context in the evaluation of pediatric sleep disorders as research continues.”
POE children are at increased risk for sleep difficulties, yet there is little guidance for caregivers about how to support kids experiencing these challenges.3 These babies’ brains have developed under difficult conditions and often do not function neurotypically. Studies have shown that POE children can have smaller brain sizes,4 lower cognitive function, developmental delays, feeding and nutrition challenges, muscle and motor diagnoses, trauma responses, chronic nervous system dysregulation, and ADHD diagnoses.5 As stated by the authors of a study published in 2020: “There is an urgent need to not only define the full spectrum of adverse infant and childhood outcomes associated with perinatal opioid exposure, but to also develop novel therapies for opioid-exposed individuals.”6
Could Sleep Solve the Problem?
Generation O: The National Organization for Opioid-Exposed Children is a nonprofit that supports caregivers through education, resources, and community. We provide information and scientific research, in plain English, about the long-term outcomes of prenatal opioid exposure. We have an online support group where 7,000 caregivers come to exchange advice, tell stories, and ask questions.
ADHD is a common diagnosis for POE children and a frequent topic of discussion. We know that sleep disorders are one of the most common comorbidities with an ADHD diagnosis.7 There have been several studies published about the connections between sleep quality and ADHD.8
As an organization, we are asking the sleep disorders community to help us answer this question: What if the academic struggles, executive function challenges, hyperactivity, emotional outbursts, and behavioral issues that so often lead to an ADHD diagnosis are actually rooted in the problems with sleep that opioid-exposed children experience from day one?
Generation O is asking the sleep medicine community for early and consistent evaluation and specialized therapy for sleep disorders in the POE population, which we believe could be essential to improving long-term outcomes.
In February 2025, Sara L. Mills-Huffnagle, MS, and coauthors published an open letter calling on the American Academy of Pediatrics (AAP) to establish a standard of care for prenatally opioid-exposed children.9 We at Generation O also call for this.
Most caregivers who leave the hospital with an opioid-exposed infant believe that once the baby is through withdrawal, they’re going to be a typical child. In many cases, this is not true. With a standard protocol of follow-up care, caregivers and children can be better supported through the unique challenges that arise after withdrawal ends. This is also a good first step toward widely acknowledging the long-term effects of prenatal opioid exposure that research has already proven and advocating for more support in the months and years beyond infancy.
Healthy Sleep Should Start in the NICU
The AAP recommends that neonatal intensive care units (NICUs) use the “eat, sleep, console” approach for newborns experiencing neonatal opioid withdrawal syndrome. The approach assesses the baby’s ability to eat, sleep, and be consoled, rather than focusing on individual withdrawal symptoms as a measure of well-being.10 It prioritizes skin-to-skin contact, a low-stimulation environment, and swaddling over pharmacological interventions. The eat, sleep, console approach significantly decreased the days until infants were medically ready for discharge, without increasing adverse outcomes.11
As an organization, we would like to see babies under the eat, sleep, console protocol monitored for more than their ability to sleep. They should also be monitored for the health of their sleep, both early and longitudinally (post-hospital discharge).
A diagnosis such as neonatal opioid withdrawal syndrome in a medical chart can serve as a flag that the child may need long-term therapies and supports. However, even if the child does not experience withdrawal symptoms in the days after birth or does not receive an official diagnosis, the long-term impacts of prenatal opioid exposure can still occur. Generation O caregivers have shared numerous stories of symptoms and struggles first arising in toddlerhood and beyond.
The Opioid Crisis Doesn’t End When Fatal Overdoses Do
Much of the work done to combat the opioid crisis has been focused on addicted adults, which is vital. However, just because fentanyl-related deaths in adults ages 18 to 44 have declined,12 due in part to naloxone availability, that doesn’t mean the opioid crisis has resolved. Tens of thousands of babies continue to be born every year who have been prenatally exposed to opioids.
The caregivers in the Generation O community beg to be supported with the same determination and urgency shown to adults in opioid addiction. These kids deserve the spotlight now—while there’s still time to intervene. The opioid crisis robbed them of a healthy start in life, and it’s our responsibility to give them every support we can to help them thrive in the future.
How the Sleep Disorders Community Can Help
Generation O wants sleep health prioritized for opioid-exposed babies from birth. Long-term monitoring and support of sleep quality could significantly improve educational and behavioral outcomes for these kids.
We also want more research done on sleep disorders and opioid-exposed children, as well as novel therapies created to treat them. Caregivers need guidance to support quality sleep in their children.
We ask you to leverage your influence wherever you can. Learn more about this population. Advocate for them. Contact us and involve Generation O in conversations. Donate to our organization to help fund our programs that provide education and support to caregivers and shine a light on this understudied and underrecognized group.
References
1. Centers for Disease Control and Prevention. About opioid use during pregnancy. CDC. 2025 May 7. Available https://www.cdc.gov/opioid-use-during-pregnancy/about/index.html.
2. Lust C, Vesoulis Z, Zempel J, et al. An amplitude-integrated EEG evaluation of neonatal opioid withdrawal syndrome. Am J Perinatol. 2024 May;41(S 01):e290-7.
3. Xu JH, Merhar SL, Defranco EA, et al. Maternal perception of infant sleep and bonding in opioid use disorder. J Addict Med. 2025 Jan-Feb 01;19(1):83-8.
4. Bann CM, Newman JE, Poindexter B, et al. Outcomes of babies with opioid exposure (OBOE): protocol of a prospective longitudinal cohort study. Pediatr Res. 2023 May;93(6):1772-9.
5. Generation O. Evidence by symptom. Generation O. 2025. Available https://generationo.org/evidence-by-symptom.
6. Vasan V, Kitase Y, Newville JC, et al. Neonatal opioid exposure: public health crisis and novel neuroinflammatory disease. Neural Regen Res. 2021 Mar;16(3):430-2.
7. Weiss MD, Craig SG, Davies G, et al. New research on the complex interaction of sleep and ADHD. Curr Sleep Medicine Rep. 2015;1:114–21.
8. Hvolby A. Associations of sleep disturbance with ADHD: implications for treatment. Atten Defic Hyperact Disord. 2015 Mar;7(1):1-18.
9. Mills-Huffnagle SL, Sullivan RE, Corr TE, Nyland JE. Call to action: Standardizing follow-up care for infants prenatally exposed to opioids. Hosp Pediatr. 2025 Mar;15(3):e121–5.
10. Gold C, Wheeler C, Hwang SS. Eat, sleep, console approach: Effectiveness, outcomes, and future considerations. Neoreviews. 2025 April;26(4):e223–32.
11. Young LW, Ounpraseuth ST, Merhar SL, et al; ACT NOW Collaborative. Eat, sleep, console approach or usual care for neonatal opioid withdrawal. N Engl J Med. 2023 Jun 22;388(25):2326-37.
12. Ahmad FB, Cisewski JA, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2025. Available https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.