What is family-centered neonatal abstinence syndrome care?

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Traditionally neonatal abstinence syndrome was treated by observing the infant for signs and symptoms of withdrawal and starting medication (such as morphine every three hours) when the symptoms become moderate to severe. Infants would be weaned off the medication over three to four weeks and then sent home. Our new approach is called family-centered NAS care (FC-NAS) and focuses on the mother (or family) as the treatment for the infant. With this new method, infants are able to go home in approximately five to 10 days.

FC-NAS uses the MOM or “Moms Over Medicine” model. You are the treatment for your baby. The mother is mentored and taught techniques to care for her infant and how to best manage NAS symptoms.

We will be looking at three measures to assess the degree of you baby’s signs of withdrawal: 1) can he/she eat, 2) sleep and 3) be consoled. The goal is for you, the mother (or family) to stay at the bedside the entire time to take care you baby; he or she will do best with you. Members of our team will be there to back you up if you need to leave for an appointment or other commitment. A room with bed and bathroom will be available to you.

Model of Treatment: Eat, Sleep, and Console

Eat, sleep, and console is a non-pharmacological treatment option for infants exposed to opioid use throughout pregnancy.

• Eat: Able to eat at least 1 ounce/feed or breast feed well. If unable to eat (too sleepy or uncoordinated), a feeding tube may be needed
• Sleep: Able to sleep for at least one hour undisturbed. May have to be held to sleep
• Console: Able to be consoled within 10 minutes. Another person should try to console baby. If still not able to console, a one time dose of morphine can be given. Baby will be on an oxygen monitor for four hours after morphine dose

• Mother is the treatment
• Staff and family partner to provide the best possible care for the infant
• Mother (or designated family member) stays with the infant the entire hospitalization
• Your baby may require an occasional dose of medicine to help them during difficult times
• Collaboration with community partners such as behavioral health, medication assisted treatment centers, and Department of Child Safety is necessary to ensure a safe plan of care for the infant

• Ideally prenatal education is started in the OB clinic and/or MAT clinic
• Family Centered Care: Goal is to have Mother and baby together in the same room throughout the hospitalization
• Create a culture of acceptance and teamwork between the mother and staff
• Support mother’s care of her baby and coach her to develop strategies to console her baby:
  • Swaddling
  • Holding
  • Rocking
  • Feeding
• Immediate intervention when infant starts crying
• Use of pacifiers
• Low stimulation environment – dim lights, minimal noise
• Focus on empowering the mother: Reduces guilt by being the solution
• Doing whatever it takes to keep the mother with the baby
• Encourage breast feeding if compliant with methadone program
• Remove barriers to mother’s presence:
  • Provide her with meals
  • Allow other children to come as needed
  • Assist in coordination with the methadone clinic
  • Work with her to give her rest/smoking breaks
• Create a team approach to care: Mother is the main caregiver. Other family members are also encouraged to support baby and mother. If none of them can be present it becomes a joint effort on the NICU team to care for the infant.