This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Babies exposed before birth to opioids, such as methadone, buprenorphine, heroin or prescribed painkillers, and sometimes to other drugs like benzodiazepines, can show withdrawal signs in the days after delivery. This is called neonatal abstinence syndrome (NAS), or neonatal opioid withdrawal syndrome. The Finnegan score, published by Loretta Finnegan in 1975 and later shortened into the modified version used here, is still the most widely used tool to measure it at the bedside.
How scoring works
The nurse observes the baby over the interval since the last score, usually 3 to 4 hours, ideally about 30 minutes after a feed. Each sign scores between 1 and 5 points, grouped in three systems:
| System | Signs scored |
|---|---|
| Central nervous system | high-pitched cry, short sleep after feeds, hyperactive Moro reflex, tremors, increased tone, skin excoriation, myoclonic jerks, convulsions |
| Metabolic, vasomotor and respiratory | sweating, fever, yawning, mottling, nasal stuffiness, sneezing, nasal flaring, fast breathing |
| Gastrointestinal | excessive sucking, poor feeding, regurgitation or projectile vomiting, loose or watery stools |
Convulsions weigh most (5 points), then continuous crying, tremors at rest, projectile vomiting and watery stools.
Example
A baby with an excessive high-pitched cry (2), sleeping less than three hours after feeds (1), a hyperactive Moro reflex (2), mild tremors when disturbed (1), frequent yawning (1), a stuffy nose (1) and excessive sucking (1) scores 9.
What the score means
| Score | Usual approach |
|---|---|
| under 8 | comfort care and scoring every 3 to 4 hours |
| 8 to 11 | significant withdrawal: three consecutive scores at this level (or an average of 8 or more) usually lead to medication |
| 12 or more | severe withdrawal: two consecutive scores at this level usually lead to medication |
Thresholds vary between units, and each hospital follows its own protocol.
Comfort care comes first
Whatever the score, first-line care is non-drug: rooming in with the parents, skin-to-skin contact, swaddling, a calm and dim room, small frequent feeds and breastfeeding when it is safe. Many units now also use the Eat, Sleep, Console approach, which asks whether the baby can feed well, sleep at least an hour and be consoled within ten minutes, and often shortens the hospital stay.
Limits
The score is subjective, and two observers can differ by several points. Fever, infection, low blood sugar or low calcium can mimic withdrawal and must be ruled out. The score was built for opioid exposure and is less reliable for other substances.