Neonatal abstinence syndrome (also called NAS) is a group of conditions caused when a baby withdraws from certain drugs he or she is exposed to in the womb before birth. And although the assumption may be that the majority of infants displaying NAS symptoms were exposed to illegal substances, that is not the case. NAS is most often caused when a woman takes opioids during pregnancy, and only 17 to 19% of these cases are from non-prescription substances.

Katie Schlosser, PT recently completed a course on development and family-focused approaches to NAS and learned this information. She was struck by the statistics and had her own assumptions based on the toddler cases she’d seen over the years. She said it’s important to educate physicians on the importance of involving therapists early on.

“A physical therapy exam within the first four days of an infant’s life is very predictive,” she said. “Physical therapy under age one can help a patient reach developmental milestones they wouldn’t have without it.” Therapists brought in for initial examination and assessment can look at midline control and midline spinal alignment or other cues to help classify the infant into a 3-level system.

• Neurological tone
• Movement quality
• Behavioral cues
• State transition quality
• Postural control
• Feeding behavior

While intervention strategies vary, emphasis on caregiver education when integrating a family-focused approach to interventions and development plans is also important. Classifying caregiver history and exposure to substances in their own life using the Adverse Childhood Events model (ACEs) is a recommended screening tool to use with NAS cases. A high ACE score will identify families who need more detailed education and attention to social emotional concerns. The score can also help therapists set appropriate progress expectations, anticipating less or more compliance with home programming.

Cases of NAS in the United States have increased at least 300% since 1999, and rural communities have the highest incidences. If we can educate our physicians on early therapy intervention, it will minimize the long-term effects for these children.