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One green bottle
  1. S Khan1,
  2. B Perraju2,
  3. TG Powell3
  1. 1Paediatrics, Wrexham Maelor Hospital, Wrexham, UK
  2. 2Paediatrics, Royal Gwent Hospital, Newport, UK
  3. 3Paediatrics, Ysbyty Gwnedd, Bangor, UK


Introduction Most paediatricians are familiar with the diagnosis and management of neonatal abstinence syndrome in babies of mothers who have taken opiate drugs during pregnancy. We report a case in which parents tried to prevent opiate withdrawal symptoms in their baby by giving her regular doses of methadone from birth without medical advice.

Case report AB presented to our emergency department at 7 months of age with respiratory symptoms and signs suggestive of a chest infection. This was her third admission within two months, the first two having been with mild RSV (+) ve bronchiolitis and with X-ray changes suggestive of aspiration pneumonia respectively. AB's family was known to social services owing to previous domestic violence and drug abuse.

During this admission nurses had noted erratic maternal behaviour culminating in the discovery of AB being fed green-coloured milk. Analysis of both the milk and AB's urine revealed significant levels of methadone. AB's blood methadone level was above the lethal range signifying high tolerance to methadone.

With no experience to guide us with this unique case we consulted colleagues from the adult drug service to determine our approach to management. We present our experience.

Conclusion We found no previous reports of parental ‘diagnosis and treatment’ of neonatal abstinence syndrome or of the medical management of opiate addiction in older babies and children.

Although this case appears unique we believe paediatricians should be increasingly alert to the possibility of clandestine methadone administration to babies by parents with a history of drug abuse.

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