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The Eat, Sleep, Console NAS Care Tool 


The most commonly used NAS assessment tool in the U.S., often modified by individual institutions, is called the Neonatal Abstinence Syndrome Score (NASS). This tool, more commonly referred to as the Finnegan Scale, was developed in 1974. It contains a list of the most common neonatal opioid withdrawal signs with points assigned for each item based on its perceived severity.  Pharmacologic treatment is titrated based on the total NASS score. Recent quality improvement (QI) initiatives have developed a new approach to guide medication treatment, focusing on the infant’s functioning; specifically, how well the infant is eating, sleeping, and how consolable the infant is.  This approach, called the "Eat, Sleep, Console” (ESC) approach, is just one component of a comprehensive family-centered non-pharmacologic care approach, and has resulted in less medication treatment in the context of QI projects. While we believe the infant should continue to be assessed for signs of opioid withdrawal with a tailored treatment approach, the ESC method’s sole principle is that the pharmacologic treatment of the infant should be primarily based on infant function and comfort, as opposed to reducing all signs of opioid withdrawal. This method of assessing infants with NAS was developed by a collaborative effort between faculty at Yale, Children’s Hospital at Dartmouth-Hitchcock, and Boston Medical Center for quality improvement purposes. 

Disclaimer: The “Eat, Sleep, Console” (ESC) Assessment Tool and Training Materials are copyrighted by Boston Medical Center Corporation, Dr. Matthew Grossman, Mary Hitchcock Memorial Hospital, Dartmouth-Hitchcock Clinic (2017).  The ESC tool was developed for quality improvement purposes and is not currently the established standard of care for the assessment of infants with NAS.  The tool is currently undergoing further rigorous study to assess maternal and infant outcomes. The ESC Tool should be implemented in the context of the standardized training provided, and always as part of a comprehensive non-pharmacologic care approach. At present, the ESC assessment tool and training materials are intended to be used only by hospital teams participating in the NeoQIC or NNEPQIN collaboratives and are not available for use by hospitals outside of these collaboratives. 

For Hospitals Participating in the NeoQIC or NNEPQIN ESC Roll-Out 

    >> Access the ESC Training Page here.

        **  Please note that this page is password protected. If you need the password, please email Nicole Iannella at

Last Updated: 1/26/21

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