Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings

Publication Date: September 30, 2024
Last Updated: November 12, 2024

Summary of Key Action Statements

Pediatricians and other pediatric health care providers (PHCPs) should treat acute pain using a multimodal approach that includes the appropriate use of nonpharmacologic therapies, nonopioid medications, and, when needed, opioid medications. (B, S)
1986747
Pediatricians and other PHCPs should NOT prescribe opioids as monotherapy for children and adolescents who have acute pain. (B, S)
1986747
When prescribing opioids for acute pain in children and adolescents, PHCPs should provide immediate-release opioid formulations, start with the lowest age- and weight-appropriate doses, and provide an initial supply of 5 days or fewer, unless the pain is related to trauma or surgery with an expected duration of pain of more than 5 days. (C, R)
1986747
When treating acute pain in children and adolescents younger than 12 years, pediatricians and other PHCPs should NOT prescribe codeine or tramadol. (X, S)
1986747
When treating acute pain in adolescents 12–18 years of age who have obesity, obstructive sleep apnea, or severe lung disease, pediatricians and other PHCPs should NOT prescribe codeine or tramadol. (X, S)
1986747
When treating postsurgical pain after tonsillectomy or adenoidectomy in children and adolescents younger than 18 years, pediatricians and other PHCPs should NOT prescribe codeine or tramadol. (X, S)
1986747
When treating acute pain in people of any age who are breastfeeding, pediatricians and other PHCPS should NOT prescribe codeine or tramadol. (X, S)
1986747
When treating acute pain in children or adolescents who are taking sedating medications, such as benzodiazepines, pediatricians and other PHCPs should use caution when prescribing opioids. (X, S)
1986747
When prescribing opioids, pediatricians and other PHCPs should provide naloxone and counsel patients and families on the signs of opioid overdose and on how to respond to an overdose. (X, R)
1986747
When prescribing opioids, pediatricians and other PHCPs should educate caregivers about safe storage and directly observed administration of medications to children and adolescents. (D, O)
1986747
When prescribing opioids, pediatricians and other PHCPs should educate caregivers about safe disposal of unused medications, help caregivers develop a plan to safely dispose of unused medications, and, if possible, offer safe disposal in their practice setting. (A, S)
1986747
When treating acute, worsened pain in children and adolescents with preexisting chronic pain, pediatricians and other PHCPs should prescribe opioids when indicated and partner with any other opioid-prescribing clinicians involved in the patient’s care and with specialists in chronic pain, palliative care, and/or other opioid stewardship programs to determine an appropriate treatment plan. (D, O)
1986747

Video

Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings

Authoring Organization

American Academy of Pediatrics

Publication Month/Year

September 30, 2024

Last Updated Month/Year

October 23, 2024

Document Type

Guideline

Country of Publication

US

Document Objectives

This is the first clinical practice guideline (CPG) from the American Academy of Pediatrics outlining evidence-based approaches to safely prescribing opioids for acute pain in outpatient settings. The central goal is to aid clinicians in understanding when opioids may be indicated to treat acute pain in children and adolescents and how to minimize risks (including opioid use disorder, poisoning, and overdose). The document also seeks to alleviate disparate pain treatment of Black, Hispanic, and American Indian/Alaska Native children and adolescents, who receive pain management that is less adequate and less timely than that provided to white individuals. There may also be disparities in pain treatment based on language, socioeconomic status, geographic location, and other factors, which are discussed.

Inclusion Criteria

Male, Female, Adolescent, Child

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management, Prevention

Diseases/Conditions (MeSH)

D000701 - Analgesics, Opioid

Keywords

opioids, Pain Management, Prescribing of Opioids, opioid analgesics

Source Citation

Https://doi.org/10.1542/peds.2024-068752

Supplemental Methodology Resources

Technical Standards, Data Supplement, Data Supplement

Methodology

Number of Source Documents
176
Literature Search Start Date
March 1, 2022
Literature Search End Date
June 1, 2023