COMMON SYMPTOMS

UNIQUE CONSTELLATIONS

Every day in the United States, dozens of infants are born with opioid exposure. While much attention has been focused on the immediate withdrawal period, parents and caregivers are increasingly reporting a broader set of long-term challenges in their children—challenges that extend well beyond the neonatal stage.

Through the lived experiences of families, Generation O has identified 11 common symptoms seen across children with prenatal opioid exposure. Much like Fetal Alcohol Spectrum Disorder, no two children present identically. Instead, each child exhibits a unique constellation of symptoms drawn from this shared set. These include difficulties in feeding, sleeping, regulation, vision, and other developmental domains.

At present, these constellations remain unnamed, under-recognized, and insufficiently studied in the medical community. As a result, children are often misdiagnosed, misunderstood, or left without appropriate supports. By acknowledging these symptom patterns as specific outcomes of prenatal opioid exposure, we can move toward more accurate identification, earlier intervention, and more effective long-term care.

This poster introduces the Constellation of Symptoms model developed by Generation O, illustrating the common outcomes and the unique ways they combine in individual children. Our goal is to spark dialogue among clinicians, researchers, and policymakers on the urgent need to formalize, name, and study these outcomes—ensuring that children affected by prenatal opioid exposure receive the recognition and resources they need to thrive.

Generation O believes these children deserve more than survival. They deserve to be seen, understood, and supported.

CASE STUDIES

Our case studies are based on actual opioid-exposed children in our community. Names have been changed to protect their identities.

OWEN’S CONSTELLATION

PRENATAL EXPOSURE

  • Exposed to opioids, fentanyl, heroin, methadone, cocaine, THC, and nicotine

BIRTH

  • Born via c-section at 39 weeks. Received NAS diagnosis at 36 hours old. Received an NG tube in the NICU, where he stayed for 12 days under Eat, Sleep, Console protocol. NG tube was removed upon discharge, but he has suffered from feeding challenges, slow growth, and gastrointestinal distress throughout infancy and into toddlerhood.

SYMPTOM CONSTELLATION

  • Speech and Language Delays

  • Vision issues: Nystagmus, Amblyopia, and Astigmatism

  • Developmental Differences/Delays

  • Muscle/Motor Diagnoses (Low Muscle Tone, Gross and Oral Motor Delays)

  • Feeding Challenges & Gastrointestinal Issues

  • Sensory Processing Challenges

OTHER CHALLENGES

  • Diagnosed Failure to Thrive as an infant. Is on the growth chart now but remains in the 1st and 2nd percentiles for height and weight.

  • Bangs his head on hard surfaces when frustrated and needs to wear a padded helmet at times.

FAMILY

  • Owen’s biological mother made an adoption plan prior to giving birth. Owen left the NICU with his adoptive parents.

OPAL’S CONSTELLATION

PRENATAL EXPOSURE

  • buprenorphine, fentanyl, heroin, cocaine, nicotine, Zantac

BIRTH

  • Born at 36-6/7 weeks via c-section, diagnosed with NAS, in NICU for 10 days, given morphine for withdrawal symptoms, very limited prenatal care, mother not aware of pregnancy until 5 months

SYMPTOM CONSTELLATION

  • Academic Difficulties

  • Sleep Problems

  • Chronic Nervous System Dysregulation

  • Trauma Responses

  • ADHD and Executive Function Difficulties

OTHER CHALLENGES

  • Destructive/aggressive behavior, constant need for attention, perseverance (can't stop a behavior once she's started it)

FAMILY

  • Opal lived with her biological mother for first 2.5 months, then came to adoptive family via foster care (only one placement).

ODIN’S CONSTELLATION

PRENATAL EXPOSURE

  • Heroin, percocet, methadone, benzodiazepines, cocaine, oxycodone, tobacco

BIRTH

  • Born premature at 28 weeks, no NAS diagnosis, two months and a day in the NICU

SYMPTOM CONSTELLATION

  • Trauma Responses

  • Academic Difficulties

  • Sleep Disorders

  • Speech & Language Delays

  • Anxiety/Chronic Nervous System Dysregulation

  • ADHD/Executive Function Weakness

  • Developmental Differences/Disabilities

  • Sensory Processing Challenges

OTHER CHALLENGES

  • Mental health difficulties - depression and anxiety, along with suicidality and self harm

FAMILY

  • Two NICUS, three foster homes, and then placement for adoption at age 26 months