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Welcome to our comprehensive guide and easy-to-use Finnegan Score Calculator. This clinical tool is designed to assist healthcare professionals—including neonatologists, pediatricians, residents, and neonatal nurses—in the crucial task of assessing and managing infants experiencing withdrawal. By providing a streamlined, accurate method for calculating the Finnegan Neonatal Abstinence Scoring System (FNASS), our calculator helps standardize the evaluation of Neonatal Abstinence Syndrome (NAS) and the more specific Neonatal Opioid Withdrawal Syndrome (NOWS). This guide will delve deep into the mechanics of the Finnegan score, its interpretation, and its vital role in clinical practice, while also offering a simple-to-use digital solution.
For parents and caregivers, this article aims to demystify the scoring process you may see being used for your baby, providing clarity and understanding during a challenging time. Our goal is to empower both clinicians and families with knowledge to ensure the best possible outcomes for these vulnerable newborns.
To fully appreciate the utility of an accurate NAS scoring tool, it’s essential to first understand the conditions it helps manage. Neonatal Abstinence Syndrome and Neonatal Opioid Withdrawal Syndrome are terms that describe the collection of signs and symptoms a newborn experiences after being exposed to certain substances in utero and then abruptly discontinuing that exposure after birth.
Neonatal Abstinence Syndrome (NAS) is a broad term used to describe a group of problems a newborn experiences when withdrawing from exposure to addictive substances, most commonly opioids, used by the mother during pregnancy. While opioids are the primary cause, NAS can also result from in-utero exposure to barbiturates, benzodiazepines, and sometimes alcohol or certain antidepressants (SSRIs).
In recent years, with the rise of the opioid epidemic, the terminology has evolved. The American Academy of Pediatrics (AAP) now recommends using the term Neonatal Opioid Withdrawal Syndrome (NOWS) when the withdrawal is specifically due to opioid exposure. This distinction is important because the signs and management can differ slightly from withdrawal caused by other substances. For the purpose of this guide, we will use NAS as the broader term while acknowledging that the Finnegan score is most frequently applied in cases of NOWS.
The primary cause of NAS and NOWS is the passage of drugs from the pregnant person’s bloodstream across the placenta to the fetus. The unborn baby becomes dependent on the substance along with the mother. After birth, the baby’s supply of the drug is cut off, leading to the onset of withdrawal symptoms.
The incidence of NAS has surged dramatically over the past two decades, mirroring the trajectory of the opioid crisis in the United States and worldwide. According to the National Institutes of Health (NIH), the rate of infants born with NAS has increased several-fold. This rise represents a significant public health challenge, leading to:
Standardized assessment tools, like the Finnegan score, are therefore more critical than ever to ensure these infants receive timely and appropriate care, minimizing the severity of withdrawal and improving long-term outcomes.
The Finnegan Neonatal Abstinence Scoring System (FNASS) is the most widely recognized and historically used tool for quantifying the severity of withdrawal in newborns. Developed in the 1970s by Dr. Loretta Finnegan, it provides a structured method for observing and scoring 21 different clinical signs associated with withdrawal.
The system is organized into three categories based on the physiological systems affected:
Each sign is assigned a point value based on its severity. A healthcare provider observes the infant, typically over a 3 to 4-hour period corresponding with their feeding schedule, and assigns points for each sign present during that interval. The points are then summed to produce a total score. This infant withdrawal assessment is crucial for guiding treatment decisions.
Below is a detailed breakdown of the 21 signs included in the FNASS. Our Finnegan Score Calculator automates the summation of these points, but understanding each component is vital for accurate assessment.
| Clinical Sign | Clinical Description & Scoring | Score |
|---|---|---|
| 1. Central Nervous System (CNS) Disturbances | ||
| Crying | Is the cry high-pitched and continuous or only when disturbed? | |
| Continuous High-Pitched Cry | A shrill, piercing cry that persists. | 2 |
| Excessive High-Pitched Cry | Frequent, shrill crying but not continuous. | 3 |
| Sleep | How long does the infant sleep after a feeding? | |
| Sleeps < 3 hours after feeding | Difficulty settling and staying asleep. | 1 |
| Sleeps < 2 hours after feeding | Significantly reduced sleep duration. | 2 |
| Sleeps < 1 hour after feeding | Severe sleep disturbance. | 3 |
| Moro Reflex | Is the startle reflex exaggerated? | |
| Hyperactive Moro Reflex | Easily triggered and marked by jerky movements and crying. | 2 |
| Markedly Hyperactive Moro Reflex | Very easily elicited with minimal stimulation, severe response. | 3 |
| Tremors | Are tremors present when the infant is disturbed or undisturbed? | |
| Mild tremors (disturbed) | Fine tremors only when handled or stimulated. | 1 |
| Moderate-severe tremors (disturbed) | More pronounced tremors when handled. | 2 |
| Mild tremors (undisturbed) | Fine tremors occurring at rest. | 3 |
| Moderate-severe tremors (undisturbed) | Pronounced tremors occurring at rest. | 4 |
| Increased Muscle Tone | Assessment of limb rigidity and resistance to passive movement. | 2 |
| Excoriation | Abrasions on knees, elbows, nose, or cheeks from rubbing against bedding due to hyperactivity. | 1 |
| Myoclonic Jerks | Brief, involuntary twitching or jerking of a muscle or group of muscles. | 3 |
| Generalized Seizures | Tonic-clonic movements, a severe sign of CNS irritability. This requires immediate medical attention. | 5 |
| 2. Metabolic, Vasomotor, & Respiratory Disturbances | ||
| Sweating | Visible beads of sweat on the forehead, upper lip, or back. | 1 |
| Fever (>37.2°C / 99°F) | Temperature instability, not due to ambient temperature or infection. | |
| 37.2°C – 38.3°C (99°F – 101°F) | Low-grade fever. | 1 |
| >38.4°C (>101°F) | High fever. | 2 |
| Yawning | Frequent yawning, more than 3-4 times in an observation period. | 1 |
| Mottling | Lacy, red or blue pattern on the skin due to vasomotor instability. | 1 |
| Nasal Stuffiness | Congestion without signs of a cold or infection. | 1 |
| Sneezing | Frequent sneezing, more than 3-4 times in an observation period. | 1 |
| Nasal Flaring | Widening of the nostrils during breathing, a sign of respiratory distress. | 2 |
| Respiratory Rate | Is the infant breathing rapidly? | |
| > 60 breaths/min | Tachypnea without other cause. | 1 |
| > 60 breaths/min with retractions | Tachypnea with visible pulling in of the chest wall. | 2 |
| 3. Gastrointestinal (GI) Disturbances | ||
| Excessive Sucking | Frantic, non-nutritive sucking on fists, fingers, or pacifier. | 1 |
| Poor Feeding | Disorganized suck-swallow-breathe pattern, falling asleep during feeds, or poor intake. | 2 |
| Regurgitation | Projectile or frequent spitting up after feeds. | 2 |
| Loose or Watery Stools | Diarrhea, often with redness and skin breakdown in the diaper area. | 3 |
A single score provides a snapshot, but the true clinical value of the Finnegan system lies in serial assessments. Knowing how to calculate Finnegan score is only the first step; interpretation is key to guiding effective and compassionate care.
Finnegan scores are typically performed every 3 to 4 hours, before each feeding. The trend of these scores over time is more informative than any isolated number. While protocols can vary slightly by institution, the general guidelines for interpretation are as follows:
The decision to start medication is a significant one. It’s based on these consistent, high scores, which indicate that supportive, non-pharmacologic care alone is not sufficient to control the infant’s symptoms and promote their well-being. Using a precise NOWS calculator like ours helps ensure these critical decisions are based on accurate, standardized data.
The Finnegan score is a cornerstone of managing NAS in the clinical setting. It provides an objective framework to evaluate symptoms and measure the infant’s response to treatment, whether it is non-pharmacologic or pharmacologic.
For all infants exposed to opioids in utero, and especially for those with mild withdrawal symptoms (scores <8), non-pharmacologic care is the essential first step. These simple yet effective interventions are designed to soothe the infant’s overstimulated nervous system and support their development.
When an infant’s Finnegan scores consistently remain high despite robust non-pharmacologic care, medication is necessary to manage withdrawal safely. The goal of pharmacotherapy is not to eliminate all symptoms but to reduce them to a level where the infant can comfortably eat, sleep, and grow. Common medications used include:
Once medication is started, the Finnegan score continues to be used to titrate the dose up or down. The medication is slowly weaned as the infant’s scores improve and remain consistently low, a process that can take several weeks or even months.
Our digital Finnegan Score Calculator simplifies the scoring process, reducing the risk of manual calculation errors and saving valuable time for busy clinicians. Here’s a simple guide to using it effectively:
A nurse is assessing a 48-hour-old infant born to a mother on methadone maintenance therapy. Over the last 4 hours, the nurse observes the following:
Using the calculator, the nurse selects these five signs. The tool instantly calculates a total Finnegan score of 7. This score indicates mild withdrawal. The nurse documents the score and implements a plan to focus on swaddling and a low-stimulation environment, with a plan to re-score in 4 hours.
While the FNASS has been the gold standard for decades, it is not without its limitations. It is crucial to remember that it is a tool to aid, not replace, sound clinical judgment.
In response to the limitations of the Finnegan score, the Eat, Sleep, Console (ESC) approach has emerged as a promising alternative. This function-based assessment focuses on three core questions:
The ESC model prioritizes keeping the mother or caregiver at the infant’s bedside, empowering them as the primary intervention. Pharmacologic treatment is only considered if the infant cannot meet these three functional goals, even with maximal non-pharmacologic support. Studies comparing Eat Sleep Console vs Finnegan have shown that the ESC approach can significantly reduce the need for medication and shorten the length of hospital stays. The American Academy of Pediatrics has noted the growing evidence supporting function-based assessments like ESC. Many hospitals are now transitioning to this model or using a hybrid approach.
The Finnegan Scoring System remains a foundational tool in the assessment and management of Neonatal Abstinence Syndrome. Its structured approach provides a vital language for clinicians to communicate an infant’s status and guide treatment effectively. By understanding its components, proper interpretation, and limitations, healthcare providers can use it to its fullest potential.
Our Finnegan Score Calculator is designed to support this critical work by enhancing accuracy, efficiency, and standardization. Paired with compassionate, evidence-based non-pharmacologic care and judicious use of medication, this tool can help improve outcomes for the growing number of infants affected by the opioid crisis. Whether your institution uses the FNASS, ESC, or another method, the ultimate goal remains the same: to help every infant navigate withdrawal safely and begin their life healthy and supported. At My Online Calculators , we provide a wide range of tools to assist healthcare professionals, from our APGAR Score Calculator to our Pediatric Dose Calculator.
A high Finnegan score is generally considered to be any score of 8 or greater. This threshold signifies a moderate to severe level of withdrawal that requires close monitoring and may necessitate pharmacologic intervention, especially if the scores remain high over several consecutive assessments (e.g., three scores ≥8).
A Finnegan score is typically performed every 3 to 4 hours, often timed with the infant’s feeding schedule. For infants at high risk or those with rapidly changing symptoms, scoring may be done more frequently, such as every 2 hours. Consistent, serial assessments are essential for tracking the trend of withdrawal symptoms.
The Finnegan Neonatal Abstinence Scoring System (FNASS) was developed in 1975 by Dr. Loretta Finnegan and her colleagues. It was created to provide a standardized, objective method for assessing withdrawal severity in infants born to mothers who used opioids during pregnancy, allowing for more consistent clinical management.
Yes, the Finnegan score was originally designed to assess withdrawal from a variety of substances. However, it is most extensively studied and validated for infants with Neonatal Opioid Withdrawal Syndrome (NOWS). While it can capture signs of withdrawal from other drugs like benzodiazepines or SSRIs, the scoring and treatment thresholds may be less specific for non-opioid exposures.
The primary difference is their assessment focus. The Finnegan Score is a symptom-based tool that quantifies 21 distinct signs of withdrawal. The Eat, Sleep, Console (ESC) method is a function-based approach that assesses the infant’s ability to perform three essential tasks: eat effectively, sleep for at least an hour, and be consoled. ESC emphasizes caregiver involvement and aims to reduce pharmacologic treatment by focusing on the infant’s overall well-being rather than a checklist of symptoms.
This tool is for educational and informational purposes only and should be used by qualified healthcare professionals. It is not a substitute for clinical judgment.
Source: Finnegan LP, Kron RE, Connaughton JF, Emich JP. (1975) — StatPearls, ncbi.nlm.nih.gov
Assess newborns for Neonatal Abstinence Syndrome (NAS) by selecting the observed clinical signs. The score updates automatically.
Total Finnegan Score
Score indicates mild withdrawal. Continue non-pharmacologic care and routine monitoring.
Source: Finnegan LP, Kron RE, Connaughton JF, Emich JP. (1975) — StatPearls, ncbi.nlm.nih.gov
This tool is for educational and informational purposes only and should be used by qualified healthcare professionals. It is not a substitute for clinical judgment.