Children may be prescribed opioids to control severe pain resulting from their operations. Fatal poisonings from opioid overdoses are also increasing among both children and teens. Given the current rates of opioid abuse in the country, it is critical that patients understand how to safely use these medications and dispose of them once they are no longer needed.
Before your childâ€™s operation, we encourage you to review the materials on this website. If you have questions, donâ€™t hesitate to ask your childâ€™s surgeon.
The goals of pain control are to minimize pain, keep your child moving, help him or her resume normal activities, and help to heal.
Safe pain control is the use of medication and other therapies to manage pain with the least amount of side effects. Your surgical team will work with you and your child to:
Your child's pain may be controlled with a combination of non-medication therapies and non-opioid medications. For complex procedures, your childâ€™s pain plan may also include opioids. After one to several days, the need for opioids will decrease. Use the guide below to help manage your childâ€™s pain.
Ice, elevation, and rest
Distraction with a book, game, videos, or movies; reassurance; and music
Walking and normal play, unless specifically restricted by the surgeon
Common Side Effects*
Decreases pain and fever
Nausea, vomiting, constipation, itchy skin, and agitation.
Follow package directions for dosing to avoid side effects. The dose of acetaminophen is based on your childâ€™s weight. Allow at least 4 hours between doses and do not give more than 5 doses in a day.
Non-steroidal anti-inflammatory drugs
Upset stomach (constipation or diarrhea), gas, heartburn, nausea, vomiting, and dizziness.
Serious risks: Stomach bleeding or ulcers, heart attack, and stroke.
For children who weigh less than 12 pounds or are less than 6 months old, ask your doctor if your child can take NSAIDs. Doses of ibuprofen are based on your child's weight.
Ask your doctor if they will want you to give acetaminophen and an NSAID staggered at different times.
Common Side Effects
Dizziness, nausea (very common), headache, drowsiness, vomiting, dry mouth, itching, respiratory depression (very slow breathing), and constipation.
For opioid-related constipation, you may give your child fiber-rich foods such as pear or prune juice, prunes, MiraLAXÂ®, a stool softener, a suppository, or an enema, as directed by your surgeon.
Serious risks: Prescription opioid risks include misuse, abuse, addiction, overdose (taking too much of the medication), and death from respiratory depression. In adults, we know that the risk of opioid addiction is rare when opioids are used for less than 5 days.
FDA Contraindications and Warning: Children younger than 12 years of age should not take tramadol for their pain or codeine for their cough or pain (two types of opioid medications). Also, tramadol should not be used for pain control after tonsil removal in children younger than 18 years. Both drugs are also not recommended in adolescents 12 to 18 years old and who are obese, have obstructive sleep apnea, or severe lung disease.
*Side effects reported in 3% or more of the patients in the study sample
Children with chronic pain or a history of prolonged opioid use will have an individualized plan for postoperative pain management.
Your Childâ€™s Surgeon May:
Your Child Should:
Parents: Communicate often with your child about his or her pain. Watch for adverse events or signs of misuse.
Yes, you can wait to see if your child has severe pain before filling his or her opioid prescription.
Talk with your childâ€™s doctor about this choice:
Do not share opioids. 50% of people who abuse opioids, including high school students, get them from a friend or relative.
For the safe storage of opioids:
Dispose of opioids as soon as they are no longer needed. You can locate a drug take-back program or safe drop site near you by visiting the U.S. Drug Enforcement Administration at apps2.deadiversion.usdoj.gov/pubdispsearch. If there is no disposal site near you, flush or pour any unused liquid down the drain. Mix unused pills with coffee grounds or kitty litter in a plastic bag, and then throw it in the trash.
Anyone who takes prescription opioids can become addicted. However, long-term use is rare whenĚý opioids are only taken to manage severe, postoperative pain. Opioids block pain and may give a feeling of euphoria (feel high). Taking prescription drugs to feel high is a type of prescription drug abuse.
Addiction involves seeking out the drug despite negative effects on your health, family, and work. Children may develop tolerance, meaning that over time you might need higher doses to relieve their pain. Children can develop physical dependence, meaning their body gets used to taking opioids and may have withdrawal symptoms when the medication is stopped suddenly. Tolerance and physical dependence put them at a higher risk for an overdose.
Withdrawal symptoms can include trouble sleeping, anxiety, irritability, racing heartbeat, and headaches. Withdrawal symptoms can be managed with medication and by gradually decreasing (tapering) your childâ€™s opioid dose, but this should be guided by their doctor.
Check to see that your childâ€™s pain is decreasing over the days following surgery. Call your doctor if you think your child is misusing their pain medication, experiencing tolerance, or experiencing physicalĚý dependence.
For questions and resources to help you or a loved one cope with a substance use disorder, visit the Substance Abuse and Mental Health Services Administration website at samhsa.gov or call the 24-hour helpline at 1-800-662-HELP (4357).