Citing current statistics from the Centers for Disease Control and Prevention, the American Academy of Family Physicians recently reported that the opioid epidemic is far from over. As long as the incidence of substance use disorder in pregnant women continues to rise, a growing number of babies will be born at risk for opioid withdrawal syndrome.

Newborns exposed to opioids prior to birth may develop a variety of symptoms hours or days following their delivery, including prolonged crying, irritability, difficulty sleeping, tremors, seizures and poor feeding. Starting in the 1970s, pediatric specialists used an evaluation process called the Finnigan Neonatal Abstinence Scoring System to assess the severity of NOWS in newborns. That system includes a list of 21 signs and symptoms that are scored after observing the newborn at prescribed intervals. For infants scoring eight or higher on the scale, pharmacologic therapy using drugs such as morphine, phenobarbital and clonidine has been recommended.

“The major drawback of using Finnigan is that the symptoms newborns are experiencing may be related to withdrawal, or they may be evidence of a baby being a baby,” says Washington University newborn medicine specialist Hayley Friedman, MD, MS, who cares for newborns at the Women & Infants Center at Barnes-Jewish Hospital, Washington University Physicians and St. Louis Children’s Hospital. “It’s difficult to differentiate in irritable newborn babies whether they are signaling withdrawal or hunger.”

In the mid-2010s, to address some of the problems inherent in the Finnigan system, a new, family-centered approach to the problem of opioid withdrawal was devised. Called Eat, Sleep, Console, it is replacing the Finnigan system in major pediatric centers across the country, including the Women & Infants Center. A study conducted by researchers at Yale New Haven Children’s Hospital, where the methodology was developed, showed that using this new approach caused a decrease in hospital stays for babies with NOWS from 22.4 days to 5.9 days and a decrease in the use of morphine treatment for newborns from 98% to 14%.

“Eat, Sleep, Console emphasizes the importance of managing babies with NOWS as we would any newborn needing additional care,” says Alina Lopez, MD, Washington University pediatrician at St. Louis Children’s Hospital. “We monitor all babies in the newborn nurseries for adequate feeding, undisturbed sleep and the ability to console themselves within a reasonable length of time.” This close monitoring allows the care team to identify those infants at risk of developing NOWS.

When a newborn is identified as being at risk, nonpharmaceutical therapies are the first step in treatment. “Babies who have trouble eating may need a feeding tube, a different calorie formula or bottle, or short feeds over a few hours,” says Noor Riaz, MD, MPH, Washington University pediatrician at St. Louis Children’s Hospital. “And we can provide a quiet, dimly lit room, as well as holding and rocking, swaddling or skin-to-skin contact, all of which may help babies who are exhibiting problems with sleep and consoling.”

It is only when these nonpharmaceutical therapies are ineffective that the care team considers pharmacological therapy. In such instances, a conservative dose of morphine, or similar drug, is initially administered to gauge its effects. This approach to using medication is aimed at preventing the need to wean a newborn from an additional drug.

The Eat, Sleep, Console treatment model is most successful when the newborn’s mother and other identified caregivers are present and fully committed to providing the nonpharmaceutical interventions needed. In conjunction with Eat, Sleep, Console, treatment is also offered to moms with opioid use disorder through the Clinic for Acceptance, Recovery and Empowerment, or CARE, at the Women & Infants Center.

“CARE’s mission is to provide comprehensive, respectful and unbiased care to women with opioid use disorder during their pregnancy and following delivery,” says Friedman. “The goal of all involved in treatment—including specialists in maternal-fetal medicine, neonatology, perinatal behavioral health service, psychiatry, social work, counseling, anesthesiology and nursing—is to support women and their families on their recovery path. The program aims to keep families together and diminish the stigma associated with opioid use disorder.” Friedman also notes that, when working in tandem, the CARE program and the Eat, Sleep, Console plan represent a holistic approach to helping secure a healthy future for moms and their babies.