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What Are the Speech and Feeding Challenges Associated With Neonatal Abstinence Syndrome?

Susan Holmes-Walker, PhD, RN

May 1, 2026

Question

What are the speech and feeding challenges associated with neonatal abstinence syndrome?

Answer

When we think about infants specifically, we think about antenatal opioid exposure and its direct neurological impact on the developing brain. Neonatal Abstinence Syndrome (NAS) is the withdrawal condition that can result. There are also environmental factors that can compound antenatal opioid exposure, including caregiver stress or instability, foster or kinship care placement, and socioeconomic stressors that can lead to poor coordination of care.

Neonatal Abstinence Syndrome babies may present with faster breathing or tachypnea, excessive sneezing, yawning, and hiccups, feeding difficulties, and impaired coordination of sucking and swallowing, which can lead to poor weight gain. Hyperphagia may be present, particularly in cases of methadone withdrawal. Research has also shown that antenatal opioid exposure can increase the risk of cleft lip and/or cleft palate, a condition characterized by communication, swallowing, and feeding challenges related to the anatomical challenges these babies are born with.

Delays and challenges in communication and swallowing development can occur as we age and have varying exposure to opioid medications over time. Some of these risks may linger from childhood or be the result of a medication interaction.

Early identification of populations at risk may help prevent long-term complications of opioid use. When we think of infants with antenatal exposure, we are aware of the conditions and challenges that exposure poses. For children who are in school systems or early intervention programs, understanding the impact that unintentional opioid use may have on speech and language development is important to keep in mind.

This Ask the Expert is an edited excerpt from the course, Opioids and Impact on Speech Development: What You Need to Know, presented by Susan Holmes-Walker, PhD, RN.


susan holmes walker

Susan Holmes-Walker, PhD, RN

Susan Holmes-Walker, PhD, RN, owner and founder of the Sulan Group LLC, a continuing education provider, is a registered nurse licensed in Michigan and Florida. Dr. Holmes-Walker has a diverse background in healthcare, including roles in non-opioid pain management, risk and safety, case management, continuous quality improvement, and the medical device industry, working in opioid use disorder. She is currently a Research Nurse Care Manager at Portland Health & Science University, participating in a research study aimed at improving pain management for Veterans in rural communities with high-impact chronic pain. She is committed to improving patient care in our global society, has documented success working within healthcare teams, and is committed to professional and personal growth through lifelong continuing education. Her mission is to share lessons learned from her professional career to provide continuing education for licensed health care professionals on improving the assessment and management of pain.


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