When I worked with babies withdrawing from methadone and other opiates in the 
hospital, we scored them on a neonatal withdrawal scale every 8 hours.  Three 
of the items on the scoring sheet included loose stools, watery stools, and 
excoriation.  Usually the excoriation affected the buttocks, but occasionally 
another area.  I don't have access to the scoring sheet, as I am now staying at 
home with my 17 month old nursling and his almost 4 year old brother.  But 
the diarrhea was quite common in my patients and the raw buttocks went hand in 
hand with this.  A few other items I recall are:  awake more than 2 hours after 
a feeding, inconsolable while being held, vomiting, projectile vomiting, 
respiratory rate more than 60 per minute, fever greater than 37.2, increased 
muscle tone, etc.  We had a threshold for the 8 and the 24 hours scores, above 
while the dosage of baby's withdrawal med. would be raised.  I'm not sure how the 
infant you are speaking of is being monitored and the drops weaned off.  If 
the baby has enough symptoms, the dosage may need to be raised.  We had stopped 
using tincture of opium about 5 years ago, in favor of diluted morphine.  I 
believe the morphine was 0.8mg per ml.  It was given every 4 hours around the 
clock.  They were doing research on neonatal withdrawal at the hospital.  

Jennifer Stevens, RN




In a message dated 3/7/2006 6:04:38 PM Eastern Standard Time, 
[log in to unmask] writes:
Has anyone seen severe diarrhea in an infant undergoing opiate
detoxification? If so, what successful or unsuccessful treatments were =
used?

The following info has been related to me secondhand by another health =
care
professional who seeks help. I have not seen the clients. Meanwhile, =
here is
the history thus far:

Mother "Jane" was on high levels of meperidine throughout pregnancy for
intractable severe migraine. Baby "John" is 3 wks of age, being treated =
w/
.1mg/d opium tincture for detox, while mom is receiving fentanyl for =
detox.
Hale says "The transfer of fentanyl into human milk has been documented =
but
is low."

Baby is happy and acting normally for his age but stools q 5-10 min and =
has
concomitant severe red ("scalded") diaper rash, w smooth aspect (no rash =
or
bumps).

It would of course be possible to decrease foremilk:hindmilk ratio to =
slow
digestion as a way of manipulating the baby's environment in a helpful =
way,
irrespective of whether the there is any foremilk:hindmilk imbalance. In
other words, assuming the balance between foremilk and hindmilk is just
right for a healthy baby, and given that this baby is not healthy, it =
would
be possible to effect a change in motility by [temporarily] artificially
increasing the amount of hindmilk the baby consumes.=20

However, there is a high probability that this is not primarily a
breastfeeding problem, and that breastfeeding, which is going well per =
mom,
should be left strictly alone and a non-feeding solution (topical or
systemic medication) found by the baby's pediatrician. There is a risk =
that
manipulating breastfeeding would inappropriately focus attention on the
feeding, when it is not the problem, and that making breastfeeding more
difficult, through artificial manipulation, would endanger its long-term
success.

If the breastfeeding is not the problem and will not be featured in the
solution, other than to keep it going successfully, then I am out of the
loop at this point. It is up to the pediatrician to find a solution. =
Solid
foods are of course out of the question, due to the baby's age. I can
speculate that an increase in baby's opiate dose would be constipating, =
but
as baby is emotionally happy and without distress there is no indication =
for
an increase in opiates. In regard to anti-motility agents in infancy, =
such
as loperamide, the CDC says: "The use of antimotility agents (e.g.,
loperamide, lomotil) in children 

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