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NAS indicates multisystem involvement, resulting in a cascade of symptoms. Fetal growth is disrupted, resulting in growth restriction that can independently place the newborn at greater risk of co‐morbidity (Smith et al. 2006). Normal neurobehavioural function is altered, resulting in a display of central nervous system instability, abnormal feeding behaviour, respiratory compromise and gastrointestinal symptoms (Volpi‐wise 2005; Hamden 2009). Seizure activity can manifest as a late onset symptom of diazepine withdrawal.

NAS can occur with prescribed maternal medication. Morphine‐based analgesia for long‐term protracted pain management and psychotropic drugs for mental illness are the most common. The social context of the mother requiring morphine for long‐term pain in many cases differs from that of the illicit substance user. Nonetheless, a sensitive approach is required with these parents when reiterating information about the clinical presentation of NAS, as they will have already received information in the prenatal period.

Where maternal substance use is known, it may be prudent for midwives and neonatal nurses to refer the examination to a senior paediatrician because the newborn will require a more thorough examination to assess for withdrawal symptoms.