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  • Clinical Research Article
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Early childhood growth following prenatal opioid exposure and Neonatal Opioid Withdrawal Syndrome

Pediatric Research volume 98, pages 1395–1402 (2025)Cite this article

Abstract

Background

Newborns with Neonatal Opioid Withdrawal Syndrome (NOWS) are at risk for smaller size at birth, including weight, length, and head circumference. We hypothesized that children with a history of prenatal opioid exposure and NOWS would have smaller size as infants and toddlers.

Methods

This retrospective cohort study analyzed a cohort developed from the electronic medical records of all patients who were seen in the NOWS Clinic at a free-standing children’s hospital system through age two years. Anthropometric measurements, demographics, substance and pharmacologic exposures, custodian status and nutritional data were extracted.

Results

The final sample size included 1190 subjects with 7700 patient encounters. 1153 (97%) had four or more visits in the first two years of life. Forty-four percent of height measurements were below the tenth percentile. Prenatal methadone exposure was negatively associated with later growth. Infants with lower weight, height, and head circumference were prescribed higher caloric density infant formula. Forty percent of the weight measurements were less than the tenth percentile before 6 months, and this improved to 9.3% at 18–25-month visits.

Conclusion

Children with a history of prenatal opioid exposure are at risk for later short stature. Prenatal methadone exposure specifically is associated with decreased height.

Impact

  • This large retrospective cohort study found that toddlers with a history of prenatal opioid exposure and Neonatal Opioid Withdrawal Syndrome are at risk for short stature.

  • Prenatal methadone, but not buprenorphine, exposure is negatively associated with later growth in children with a history of prenatal opioid exposure.

  • The proportion of weight under the tenth percentile improved from infant to toddler ages in children with a history of prenatal opioid exposure.

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Fig. 1: Scatterplots of weight z-score, height z-score, and head circumference z-score by age for children with a history of prenatal opioid exposure or Neonatal Opioid Withdrawal Syndrome.
Fig. 2

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to acknowledge and thank Dr. Nichole Nidey for her advice and support of this study.

Author information

Authors and Affiliations

  1. Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Kera McNelis

  2. Emory University, Atlanta, GA, USA

    Kera McNelis

  3. University of Iowa College of Public Health, Iowa City, IA, USA

    Grace Gerdts

  4. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Maya Khan & Jennifer McAllister

  5. University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Maya Khan & Jennifer McAllister

Authors
  1. Kera McNelis
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  2. Grace Gerdts
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  3. Maya Khan
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  4. Jennifer McAllister
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Contributions

K.M. conceptualized and designed the study, curated data, and drafted the initial manuscript. G.G. performed the formal analysis of the data and critically reviewed the manuscript. M.K. acquired the data and critically reviewed the manuscript. J.M. conceptualized and designed the study, curated data, and critically reviewed the manuscript. All authors approve of the final version of the manuscript and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Kera McNelis.

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Competing interests

The authors declare no competing interests.

Ethics approval

Institutional review board approval was obtained for this study, CCHMC 2022:1065, and determined that patient consent was not required.

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McNelis, K., Gerdts, G., Khan, M. et al. Early childhood growth following prenatal opioid exposure and Neonatal Opioid Withdrawal Syndrome. Pediatr Res 98, 1395–1402 (2025). https://doi.org/10.1038/s41390-025-04006-z

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