As the 13-day-old infant scrunched up his face and squirmed in obvious pain, Addy Schultz tightened her embrace. The baby relaxed in her arms almost instantly.
"When he cramps up, I hold him harder and pat a little firmer," explained Schultz, 72, sitting in a rocking chair in the newborn intensive care unit at Thomas Jefferson University Hospital. "They don't like to be stroked or caressed."
"They" are the most helpless, hapless victims of the opioid epidemic:babies born addicted to the prescription or illicit drugs their mothers took. Many of them spend weeks or months in the hospital, gradually being weaned from opioid dependence by getting decreasing doses of oral morphine or methadone.
Even mothers who are in recovery may not be able to visit their babies every day over such a long period, so many hospitals have enlisted helpers — volunteer cuddlers like Schultz.
"These babies going through withdrawal need to be held for extended periods," said Jane Cavanaugh, the nurse who created Jefferson's cuddler program a year ago. "They need human touch. They need soothing. They need talking."
Or other comforting sounds.
"I hum and chant," said Schultz, of Haddon Township. "My kids would say I can't carry a tune in a paper bag."
All newborns need such nurturing. But for those in the throes of neonatal abstinence syndrome, or NAS, cuddling helps relieve the drug-induced turmoil in their nervous and digestive systems. The babies' symptoms include tremors, muscle spasms, shrill crying, irritability, sweating, indigestion, diarrhea, vomiting, poor sleeping, fever.
Studies going back to the late 1980s and '90s — when cuddlers were enlisted to calm crack-addicted infants — have shown the benefits of the added attention, including faster weight gain and shorter hospital stays.
"These volunteers are a godsend. They are wonderful as far as pacifying the babies," said Maryann Malloy, a nurse manager at Einstein Medical Center, another Philadelphia hospital with a similar initiative.
Cuddling isn't exclusively for babies going through withdrawal. Pennsylvania Hospital, for example, has a 30-year-old program, initially begun to provide extra TLC for premature babies in its large newborn intensive care unit.
But the opioid crisis has amped up the need. In Pennsylvania, the rate of newborn hospital stays for substance-abuse problems soared 250 percent from 2000 to 2015, when nearly 20 out of every 1,000 newborns faced withdrawal issues, according to a recent report by the Pennsylvania Health Care Cost Containment Council. The council estimated the hospitalizations added almost 28,000 days and $20.3 million in costs.
Even women who try to get off drugs when they learn they are pregnant may not be able to protect their babies. That's because going cold turkey while pregnant increases the risk of miscarriage. So moms-to-be seeking addiction treatment are usually put on methadone — and thus give birth to opioid-dependent babies.
In the Philadelphia area, Einstein and the Virtua Health System in South Jersey are among centers that have trained volunteer cuddlers in response to the crisis.
"Babies with NAS are among the most vulnerable infants in need of cuddling, as the process of opioid withdrawal is so very difficult for them to endure," said Arlene J. Verno, a developmental specialist in Virtua Voorhees' neonatal intensive care unit.
Cavanaugh, who has been a newborn critical-care nurse at Jefferson for 42 years, worked with the hospital's volunteer coordinator to create a four-hour training class for the cuddlers. After the state certifies that they have never abused a child, cuddlers learn about hand-washing and infection control. Like the babies' parents, cuddlers also are taught how to wrap and hold the babies.
"We swaddle them tightly and hold them firmly," Cavanaugh said. "The babies need that because they shake so badly. It brings comfort and control. But we want their hands free so they can touch their face and put their fingers in their mouth."
The volunteers don't feed babies or change diapers, and their three-hour shifts are always under the supervision of a nurse.
Jefferson now has 25 trained snugglers, including students, employees, and retirees.
Schultz, a speech therapist at Jefferson, cut back from full time to part time about a year ago. That freed her to spend an afternoon each week holding babies — and satisfying her (so far) unmet craving for grandchildren.
"I’ve always loved babies and holding babies," she said as she grasped the trembling hand of the baby boy, who was born two weeks early, weighing just over five pounds.
Research suggests that babies like him can do well over the long term, but it depends on family and social-service supports. Schultz tries not to dwell on the implications of the addiction epidemic.
"One time I thought: 'What am I doing here? I’m just a drop in the bucket,' " she said. "But what I decided to do was just give the babies a lot of positive energy. I say: 'You’re going to be OK. You're going to be happy. And you're going to have a wonderful life.' "
The cuddlers aren't just good for the babies. The extra arms have relieved a strain on Jefferson's nurses, who sometimes have 10 or 12 babies going through withdrawal out of 25 infants in intensive care. And the volunteers often serve as ambassadors to parents.
"Sometimes the moms feel stigmatized," Cavanaugh said. "They feel the nurses are judging them."
"When I see the parents," Schultz said, "I say, 'Oh, what a beautiful baby,' and 'Congratulations.' They’re doing the best they can."