Neonatal Abstinence Syndrome

Priority 5: Nutrition

NAS NutritionPractice lags behind policy in terms of supporting breastfeeding in women receiving medication-assisted treatment, particularly for Black women. Provider education on best practices and support for this population is necessary to improve outcomes. Research shows that breastfeeding decreases symptom severity, infant pharmacologic use and length of pharmacologic treatment.

However, despite most pregnant women reporting plans to breastfeed, relatively few infants with neonatal opioid withdrawal syndrome are exclusively breastfed at hospital discharge postpartum. . Standardized policies, practices and support systems in caring for opioid-exposed infants – particularly care that focuses on family engagement and nonpharmacologic care – can reduce the likelihood of extensive inpatient stays and medication therapy.


  • Implement bundles for non-pharmacologic feeding supports.
  • Consider on-demand feeding as routine nonpharmacologic management.
  • Promote breastfeeding, pumping expressed breast milk and use of human milk products when possible.
  • Encourage infant sucking behaviors that are associated with decreased agitation.
  • Consider hypercaloric formulas for suboptimal growth and alternative formulas if there is feeding intolerance.
  • Provide a written feeding schedule and encourage caregivers to maintain the regimen until the follow-up pediatric evaluation.
  • Consider protocols for occupational, speech and other therapies.

For more information on NJHA’s activities to improve maternal and child health,