Score the Finnegan Neonatal Abstinence Scoring System (Finnegan et al., 1975): 21 withdrawal signs in three groups — central nervous system, metabolic/vasomotor/respiratory, and gastrointestinal — each with its clinical weight. Total 0–42, with interpretation bands and a serial-score trend tracker.
Select the description that best matches the infant for each of the 21 signs, covering the full observation interval (typically 4 hours after a feed). Scores update live below.
Enter a total score — or use the live total from the checklist tab — to see the interpretation band.
| Score | Band | Usual meaning |
|---|---|---|
| 0–7 | Observation | Withdrawal unlikely or mild. Routine monitoring and non-pharmacologic care per protocol. |
| 8–12 | Consider therapy | Monitor closely. Two to three consecutive scores of 8 or above commonly trigger consideration of pharmacologic treatment. |
| 13–42 | Pharmacologic therapy | Significant withdrawal. Initiate or escalate treatment per institutional protocol. (Some protocols use 12 rather than 13 as the severe threshold.) |
Finnegan scores are usually recorded about every 4 hours. Enter each score to watch the trend — the key clinical trigger is two to three consecutive scores of 8 or above.
Scores stay in your browser only (nothing is uploaded). Trend entries are a documentation aid for trained staff, not a treatment order.
Developed by Dr. Loretta Finnegan and colleagues in 1975, it is a structured checklist of 21 withdrawal signs grouped into central nervous system, metabolic/vasomotor/respiratory, and gastrointestinal disturbances. Each sign carries a weight of 1 to 4 points reflecting severity; the weights add up to a total score that guides treatment decisions for neonatal abstinence syndrome (NAS), also called neonatal opioid withdrawal syndrome (NOWS).
The theoretical maximum is 42, the sum of the highest weight in each of the 21 rows. In practice scores rarely approach this, and treatment decisions are driven by the thresholds at 8 and 12 to 13. Note: the original 1975 publication described 31 assessment parameters; the 21-item version used here is the modified system used in modern practice.
Below 8: observe. From 8 to 12: monitor closely and consider therapy — two or three consecutive scores of 8 or higher commonly lead to treatment. At 13 or above: pharmacologic treatment per the institution's protocol. Some protocols use 12 rather than 13 as the severe threshold, so always follow the local protocol together with clinical judgment.
Typically every 4 hours after a feed, covering the whole observation interval — the score records every qualifying sign seen during that interval, not only the signs present at the exact moment of recording. The baby is woken to test reflexes such as the Moro response.
Trained clinicians, usually bedside nurses who have completed inter-rater reliability training for the tool. It is a clinical assessment instrument, not a home test and not a substitute for diagnosis.
No. The score quantifies observed withdrawal signs; diagnosis and treatment require clinical judgment together with the exposure history, timing of onset, and exclusion of other causes. A score is one input to the decision, not the decision itself.
A baby with an excessive high-pitched cry (2), hyperactive Moro reflex (2), moderate-severe tremors when disturbed (2), sweating (1), and poor feeding (2) scores 2+2+2+1+2 = 9, which falls in the 8 to 12 band: consider therapy and monitor closely, especially if repeated scores stay at 8 or above.
Tremors at rest, with the baby untouched, signal greater central nervous system irritability than tremors that only appear when the baby is handled. Mild undisturbed tremors score 3 and moderate-severe undisturbed tremors score 4, the highest single weight on the scale.
It was validated in term infants. Preterm babies may show withdrawal differently — for example, lower peak scores — so results in preterm infants must be interpreted with extra caution and clinical judgment.
Yes. The Eat, Sleep, Console (ESC) approach assesses function — whether the baby can eat, sleep, and be consoled — rather than counting individual signs, and many centers have moved to it or use it alongside Finnegan scoring. Local protocol decides which tool is used.
Free tool by NRTechStudio
Explore similar health tools and calculators. 100% free, accurate, and runs completely in your browser without sign-up.
2 taps, no typing needed — diagnostics are sent automatically.