He's less than two weeks old, but he has the telltale signs of a baby in pain: a sore on his chin where he's rubbed the skin raw, along with a scratch on his cheek. He suffers from so many tremors that nurses watch him around the clock in case he starts seizing — or stops breathing.
The baby is one of many infants born dependent on drugs. He is being treated at East Tennessee Children's Hospital in Knoxville, where doctors and nurses are on the front lines fighting the nation's prescription drug epidemic. Drug abuse in the state is ranked among the nation's highest, according to some estimates.
The hospital expects to treat 320 children this year for drug dependence, known as neonatal abstinence syndrome — up from 33 in 2008. Last year, the hospital treated 283.
"It blew us away," Andrew Pressnell, a nurse at the unit, said of the dramatic increase. "We didn't know what to do."
States across the US have passed laws to crack down on prescription drug abuse, including in the poor, mountainous Appalachian region, where the drugs were easily available as they flowed north from so-called "pill mills" in Florida.
The US government doesn't track the number of babies born dependent on drugs. A study published last year in the Journal of the American Medical Association found that more than 13,000 infants were affected across the US in 2009.
Tennessee is the first state to track the number of babies born dependent on prescription drugs, said Stephen W. Patrick, a neonatologist at the University of Michigan and one of the authors of the study.
The preferred way to treat drug-dependent babies at the Tennessee hospital is by giving them small doses of an opiate and gradually weaning them off, said Dr. John Buchheit, who heads the neonatology unit. So every few hours, the staff will give the infants morphine to help them get their symptoms of withdrawal under control. They'll be weaned off over a period of either days or weeks, Buchheit said.
"The problem is the side effects of morphine," Buchheit said. "The one we worry about — the biggie — is that it can cause you to stop breathing."
Roughly half of the neonatal unit's 49 infants are being treated for drug dependence. For those infants, the pain can be excruciating. The doctors and nurses who treat them say the babies can suffer from nausea, vomiting, severe stomach cramps and diarrhea.
"Diarrhea so bad that their bottoms will turn red like somebody has dipped them in scalding water and blistered and bled," said Carla Saunders, a neonatal nurse practitioner who helps coordinate the treatment at the hospital.
They have trouble eating, sleeping and in the worst cases suffer from seizures. Many suffer from skin conditions and tremors. Nurses place mittens on their hands because the babies get so agitated that they constantly scratch and rub their faces.
And they are inconsolable.
A small army of volunteers called "cuddlers" help the staff by holding the infants, rocking them and helping them ride out their symptoms.
Many of the babies have private, dark rooms with high-tech rocking machines to keep them calm.
Bob Woodruff, one of the 57 cuddlers for the hospital, gently rocks Liam, a 10-day-old infant who was born drug-dependent. The 71-year-old retired professor moves from room to room, wherever he's needed.
"It's very satisfying," he said.
It is impossible to be unmoved by these infants, said Saunders, the neonatal nurse practitioner.
"If there is anything that could drive the people in our society to stop turning their heads to adult addiction," she said, "it's going to be the babies."
Part of the solution to drug-addicted babies is better education — Tennessee Department of Health Commissioner John Dreyzehner is part of a group lobbying the Food and Drug Administration to put a warning on prescription drug bottles of the dangers of taking drugs while pregnant.