Helping Babies With NAS: What We Know About Feeding Challenges
Babies born to mothers who used opioids during pregnancy can experience something called Neonatal Abstinence Syndrome (NAS) — withdrawal symptoms that happen when the baby is no longer exposed to the drug after birth. One of the biggest challenges for these babies is feeding. They may struggle to eat well, which can slow their weight gain and keep them in the hospital longer.
A recent review by researchers Kailey Taylor and Denise Maguire looked at what we know so far about feeding babies with NAS. Here’s what they found…
The Study:
Title: A Review of Feeding Practices in Infants With Neonatal Abstinence Syndrome
Published in Advances in Neonatal Care • (2020) Vol. 20, No. 6 • pp. 430–439
Summary in Plain English :
Feeding babies with NAS can be challenging — and researchers recently set out to understand why. Here’s what they found…
Breast Milk Helps
Babies with NAS who are fed their mother’s own milk tend to have:
Milder withdrawal symptoms
Fewer medications
Shorter hospital stays
This is likely because breast milk not only provides nutrition, but also soothes and calms babies. Unfortunately, not all moms are able or willing to breastfeed, especially those on medications like methadone. Only about 1 in 4 mothers on methadone start breastfeeding, and far fewer are still doing so by the time their baby is discharged.
Feed When the Baby Is Ready
Instead of feeding on a strict schedule, experts recommend “demand feeding” — feeding the baby when they show signs they’re hungry. While there’s limited research to prove this method is better, some early findings and clinical experience suggest:
Frequent, small feedings are easier for babies to handle
Comfort feeding may help them gain weight
Letting babies set their own rhythm may reduce stress for both baby and caregiver
Pay Attention to Baby’s Cues — Especially If They’re Hard to Read
Babies with NAS often don’t give clear signals when they’re hungry or full. During feeding, they may:
Fuss or cry more
Have trouble staying awake
Show uncoordinated movements
Spit up or refuse to eat
One study found that during feedings, NAS babies fussed or cried over half the time, and spent less than a quarter of the time actually feeding. These behaviors make feeding stressful and frustrating for caregivers. Learning to read even subtle feeding cues is key.
Why This Matters
Feeding problems in babies with NAS can lead to:
Poor weight gain
Longer hospital stays
More stress for caregivers
Though we know a few best practices — like using breast milk and watching the baby’s cues — there’s still a lot we don’t know. More high-quality research is needed to figure out the best feeding techniques, schedules, and strategies that work for these uniquely vulnerable babies.
Bottom Line:
Feeding babies with NAS is tough, but we’re learning more. Breast milk can help. Flexible, responsive feeding may be better than rigid schedules. And caregivers need support in reading the baby’s signals — especially when those signals are hard to spot.
Many thanks to the authors of this article: Taylor, K., & Maguire, D.
