This commentary discusses why the Eat, Sleep, Console (ESC) approach for neonatal opioid withdrawal syndrome has not been adopted consistently despite evidence that it can reduce hospital stays and medication use. The authors highlight staff education, supportive relationships, and family participation as important implementation factors, while identifying limited space, staffing, caregiver time, language access, stigma, and systemic inequities as barriers. They call for practical supports that allow families to participate in infant care and for better measurement of differences in access and outcomes. This article is a commentary on implementation and equity, not a new clinical trial.
