Recent research adds to the evidence supporting a shift toward greater emphasis on mother-child bonding in the care of newborns who were exposed to drugs such as opioids before birth. 

Among babies with neonatal abstinence syndrome, those treated with the Eat, Sleep, Console (ESC) approach have shorter length of hospital stay and are less likely to be prescribed maintenance dosing of morphine than are those treated with the Finnegan Neonatal Abstinence Scoring System (FNASS), the data indicate. 

“Taken together with previous literature, and based on the demonstrated benefits towards reducing length of hospitalization and pharmacological treatment, the results of our study support a more widespread adoption of the ESC approach,” wrote study author Nicholas Swyngedouw, PharmD, of the University of British Columbia, and colleagues. 

Their results were published on August 12 in Paediatrics & Child Health.

Family Involvement Needed 

Canada is one of many nations coping with the toll of opioid use disorder on its population. Hospitalizations for neonatal abstinence syndrome rose from 1013 in 2010 to 1755 in 2020, a 73% increase, according to government data. As is common in Canadian health statistics, these figures do not include data from Quebec. 

Researchers at Kelowna General Hospital in British Columbia reviewed paper and electronic charts to compare how neonates fared under the different approaches. For this study, they excluded patients with certain significant comorbidities, including presumed sepsis and a need for respiratory support beyond day 5 of life. The researchers compared results for 34 neonates cared for with the FNASS system and 16 with the ESC approach.

The mean length of hospital stay for the infants in the ESC group was 19.5 days, compared with 27.5 days for the FNASS group (P = .039). The percentage of neonates prescribed maintenance dosing of morphine was 100% in FNASS patients and 43.8% in ESC patients. The number of weaning doses required was 64% lower in the ESC group.

The researchers acknowledged the limits of their study, including its reliance on reports from one center. 

The ESC approach derives from work that began around 2010 at Yale New Haven Children’s Hospital in Connecticut. A multidisciplinary team there began emphasizing alternatives to the pharmacologic care of newborns who had been exposed to opioids. They stressed the importance of preparing parents to handle the needs of newborns with neonatal abstinence syndrome.

“On the inpatient unit, we explained that our first-line and most important treatment would center around measures to comfort the infant and that these should be performed by a family member,” Matthew Grossman, MD, professor of pediatrics at Yale School of Medicine, and coauthors explained in a 2017 article in Pediatrics.

The ESC approach was put to the test through a cluster-randomized, controlled trial conducted at 26 US hospitals. The number of days from birth until readiness for hospital discharge was 8.2 in the ESC group and 14.9 in the FNASS group. The data were published in 2023 in The New England Journal of Medicine. 

It’s not clear how many hospitals have shifted toward ESC-based approaches for newborns with neonatal abstinence syndrome, Grossman told Medscape Medical News. “Change is hard,” he said.

Compassionate Care 

Commenting on the research for Medscape Medical News, Eric Cattoni, MD, medical director of the Families in Recovery clinic at BC Women’s Hospital + Health Centre in Vancouver, said that the difficulty of changing ingrained approaches in healthcare systems is a hurdle to the wider adoption of the ESC approach. Cattoni was not involved in the study. 

“When people have been practicing a certain way for some time, there’s clinical comfort with the old way of doing things,” he said. But the FNASS approach emphasizes repeatedly scoring the symptoms and using medication to address them, which often results in newborns spending time in incubators.

“They’re put in warm, dark boxes, separated from the birth parent, often on the wrong assertion or assumption that maybe this mother is dangerous to be around her child,” Cattoni said.

The ESC approach instead seeks to keep the newborn in the room with the mother where possible. “We know that by keeping the mother and baby together, moms do better. Babies do better. This is not a surprising outcome,” Cattoni said. 

Explaining the ESC approach to community groups often leads to a bit of levity, he added. “I’ll speak with Indigenous elders, and they’ll laugh, ‘We could have told you that 1000 years ago.’” 

The increased use of ESC is part of a trend toward more compassionate care of mothers who have opioid use disorder, said Marcela Smid, MD, medical director of the University of Utah’s SUPeRAD (Substance Use and Pregnancy – Recovery, Addiction, Dependence) Clinic in Salt Lake City. Smid cowrote the Society for Maternal-Fetal Medicine’s 2025 position statement on the decriminalization of substance use in pregnancy. She was not involved in the current study. 

ESC may not be the right approach for every family, Smid said. A woman who is beginning to recover from addiction may not be able to cope with the demands of caring for a newborn without significant help, which may not be available to her. 

“It’s very isolating” to spend time mostly alone with the newborn, as happens with the ESC approach, Smid said. “A lot of our moms don’t have a social network, or they may have other children, and they can’t be in the hospital with this child for 7 days without somebody taking care of their other kids.”

Still, ESC is the best standard of care for these newborns, even though decisions about using this approach should be made on a case-by-case basis, Smid said. “This framework sends the message that the best thing for this child is to be with parents,” Smid told Medscape Medical News.

The study was supported by British Columbia’s Interior Health Pharmacy Services. Grossman reported work with consultant Epifluence. Swyngedouw, Cattoni, and Smid reported no relevant financial disclosures. 

Kerry Dooley Young is a freelance journalist based in Washington, DC. She has covered medical research and healthcare policy for more than 20 years.