This version was machine-translated from German and has not been medically reviewed. The authoritative version is the German version.

Eat, Sleep, Console (ESC) in neonatal opioid withdrawal

Decision aid without score: Can the child eat, sleep and be consoled? From this follows a discussion with the parents or a team meeting (Grossman 2017, ESC-NOW 2023)

Since the last assessment

Eating: Does the child, because of withdrawal, need more than 10 minutes until feeding works, feed at the breast for less than 10 minutes or from the bottle less than 10 ml?

Yes only if withdrawal is the cause; if in doubt, yes and continue to observe.

Sleeping: Does the child sleep for less than 1 hour(s) at a stretch because of withdrawal?

Soothe: Does the child, because of withdrawal, need more than 10 minutes to settle, or not stay calm for 10 minutes?

Soothing aid

Course and measures

At the last assessment, the same question was already Yes (or the soothing aid was already 3)

The non-drug measures have been fully exhausted

For example rooming-in, parents with the child, feeding on demand, skin contact, swaddling, quiet environment.

Other serious signs (for example seizure, apnea)

Weight loss over 10 % since birth

Gestational age (optional) (weeks)

Calculation aid for healthcare professionals: the calculator reproduces what the sources cited assign to the inputs. Clinical assessment and every treatment decision remain with the treating physician. Inputs and results are not stored.

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Sources

An Initiative to Improve the Quality of Care of Infants With Neonatal Abstinence Syndrome (Pediatrics 139(6):e20163360) Grossman MR, Berkwitt AK, Osborn RR, et al., 2017. Quality improvement project, full text read (PMC5470506); first description of the ESC approach
Eat, Sleep, Console (ESC) Inter-rater Reliability Tool, 3rd edition 1.30.20 – © 2017 Boston Medical Center Corporation, Dr. Matthew Grossman and Children's Hospital at Dartmouth-Hitchcock Boston Medical Center / Grossman / Children's Hospital at Dartmouth-Hitchcock (via IDeA States Pediatric Clinical Trials Network), 2020. Assessment form, read; own German wording in the calculator
Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal (N Engl J Med 388:2326–2337) Young LW, Hu Z, Annett RD, et al.; ACT NOW Collaborative, 2023. Randomized trial (ESC-NOW), full text read (PMC10433732)
Eat, Sleep, Console (ESC) Assessment Tool (Form 376904, 03/25; adapted with permission from Perinatal Services BC) Shared Health Manitoba, 2025. Assessment form with definitions, read

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Note

Calculation aid for healthcare professionals. Clinical assessment remains with the treating physician.

Review date of the German original: 2026-11-08 · Methodology

Frequently asked questions

Eat, Sleep, Console (ESC) in neonatal opioid withdrawal: What does this calculator compute?

Eat, Sleep, Console (ESC) assesses newborns with opioid withdrawal (NOWS, neonatal opioid withdrawal syndrome) with 3 questions: is the infant unable to feed well because of withdrawal, unable to sleep for 1 hour, or unable to be consoled within 10 minutes? Plus the soothing aid needed (1–3). There is no score. One Yes leads to a conversation with the parents, a second consecutive Yes despite exhausted measures to a team meeting on whether medication is needed. Own German wording based on the form from Boston Medical Center and Dr. Grossman (© 2017); for newborns from 36 weeks.

Eat, Sleep, Console (ESC) in neonatal opioid withdrawal: Which sources is this calculator based on?

Grossman MR, Berkwitt AK, Osborn RR, et al.: An Initiative to Improve the Quality of Care of Infants With Neonatal Abstinence Syndrome (Pediatrics 139(6):e20163360) (2017); Boston Medical Center / Grossman / Children's Hospital at Dartmouth-Hitchcock (via IDeA States Pediatric Clinical Trials Network): Eat, Sleep, Console (ESC) Inter-rater Reliability Tool, 3rd edition 1.30.20 – © 2017 Boston Medical Center Corporation, Dr. Matthew Grossman and Children's Hospital at Dartmouth-Hitchcock (2020); Young LW, Hu Z, Annett RD, et al.; ACT NOW Collaborative: Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal (N Engl J Med 388:2326–2337) (2023); Shared Health Manitoba: Eat, Sleep, Console (ESC) Assessment Tool (form 376904, 03/25; adapted with permission from Perinatal Services BC) (2025)