Characteristics

• May go through withdrawal - up to 6 months especially with poly drug use
• Diarrhoea, abdominal distension, vomiting
• Siezures, jitteriness, tremulous, shaky limbs
• High pitched cry – difficult to comfort
• Temperature instability – cold and mottled or hot and sweaty
• Sneezing, yawning, stuffy nose, tears
• Decreased alertness
• Feeding problems – difficulty sucking
• Wakefulness – irregular sleep patterns, stressfull,
• Failure to thrive – height & weight growth deficiencies – often very fragile – poor muscle tone

Intervention & Management

Set the environment

• Keep environment calm and quiet - dim lights
• Ease the fragile sensory system into the world
• Limit number and type of objects hanging from celings and walls
• Use calm colours such as pastel blue, light green or pale yellow (avoid orange, red)
• Protect baby from being overwhelmed - too much bright light, noise, talking and music
• cover crib with a thick dark cover
• Position to provide most comfort
• Slowly introduce new sights and sounds
• Create fetal position – legs tucked, arms together, hand to mouth
• Identify comforting textures

Allow for regulated sleep wake patterns

• Feed first before changing and bathing
• Interrupt schedule as little as possible to allow for deep sleep cycles for healing and for baby to regulate herself
• Offer pacifiers – sucking calms and organizes
• Swaddle to help control movement - wrap baby with hands close together not by her sides
• Move baby gentle and rock up and down if it helps
• Provide soft sounds – voice, soft music, heartbeat, fan

General

• Provide skin to skin contact
• Hold, stroke or massage baby
• Avoid over stimulation and chaos
• Some babies don’t like eye contact and need to be held facing away
• Limit the number of caregivers who care for the baby
• Try to control prolonged crying - move to a dark quiet room, swaddle baby, hold against your chest with her ear at your neck, breathe at the same rate as the baby for 30 seconds, then slowly reduce your breathing rate
• Watch for upper respiratory and ear infections

Feeding

• You may need to wake baby to feed or use preemie or juice nipples
• Never prop a bottle
• Avoid tube feeding (could delay eating development)
• Feed small amounts every hour if necessary
• Reduce distractions - if fussy feeder you may need to withdraw to quiet area away from others
• Be alert for dehydration – this is a major concern
• Avoid fatigue
• Maintain regular appointments with Child Health Clinic to monitor progress