My baby was exposed to opioids. How will he sleep?
It is very common for newborns with prenatal opioid exposure to have sleep difficulties. A baby with “prenatal opioid exposure” is one who has been exposed to opioids while his biological mother was still pregnant. Sleeping for short amounts of time is one of the symptoms clinicians may look for when deciding whether to treat a newborn for neonatal abstinence syndrome (when a baby withdraws from certain drugs he’s exposed to in the womb before birth).
What can sleep look like in a newborn who was exposed to opioids?
At the moment, we can’t predict which babies who were exposed to opioids before birth will have problems sleeping and which will not. We do know that some newborns exposed to opioids and other substances such as alcohol, tobacco, and marijuana spend more time awake, less time asleep, and may have more “active” sleep and less “quiet” sleep (these are stages of sleep in newborns).
It may also be difficult for your newborn to have a consistent “sleep cycle.” In other words, your baby may not have a regular sleeping pattern. For example, a newborn who has not been exposed to opioids often sleeps soon after eating and can stay asleep for up to 3 hours. Instead, your newborn (with prenatal opioid exposure) may only fall asleep for 20-30 minutes after eating and may wake up crying.
How can I help my baby who was exposed to opioids sleep in the hospital?
Many newborns with prenatal opioid exposure need a quiet, dark environment. Tight swaddling can also help newborns who have tremors or jerky movements. When possible, encourage skin-to-skin contact between you (or a trusted primary caregiver) and your baby. More time spent with skin-to-skin contact, and breastfeeding, are related to shorter hospital stays for newborns who have been exposed to opioids prenatally.
How can I help my baby sleep once we get home?
Once your baby comes home from the hospital he might still be sensitive to lots of light or sound. Try to keep lights dim when your baby is sleepy and reduce noise. Turn off the TV. Try to limit visitors (unless they are helping to put the baby to sleep!). Speak softly and swaddle, hold, and rock your baby if he is jittery. If your apartment or house is noisy, a white noise machine may help. Baby massage can also help settle your newborn. Gently rub baby lotion on your baby, and move his legs toward his stomach in case your baby has gas. If you notice your baby’s fussiness starts to increase try to give him extra snuggles. You cannot spoil a baby by holding him too much. Skin-to-skin contact is very soothing for babies.
What can sleep look like in babies and toddlers with prenatal opioid exposure?
Unfortunately, we know very little about how babies with prenatal opioid exposure sleep once they are at home. There is some research showing that sleep problems in the hospital, such as sleeping for short periods of time, can last up to 3 months. Some babies might be very fussy, cry a lot, and show signs of colic. These babies might spend more time awake during the day than babies who were not exposed. For example, naps might be short (20 minutes) and there might be long periods of awake time spent between naps. As they get older, toddlers might wake up earlier in the morning and sleep less at night.
Elisabeth Conradt, Ph.D., a Pediatric Sleep Council guest contributor, is an Associate Professor of Psychology at the University of Utah who studies the developmental consequences of exposure to early life stress. She completed her doctorate at the University of Oregon and clinical internship in infant mental health at the Children’s Hospital of Philadelphia. Dr. Conradt became interested in the biobehavioral development of children with prenatal substance exposure at Brown University, where she completed her postdoctoral training. Her two lively boys have taught her about the importance of a good night’s sleep for both mom and child.