In Brief | Paediatrics & Neonatology

American Academy of Paediatrics releases the first clinical guidelines for opioid prescriptions in children with acute pain

Originally published: Paediatrics, 30 September 2024. Summary of technical report as presented at the American Academy of Paediatrics Annual Meeting held between 26-30 September 2024
 

 

 

In response to the growing concerns about opioid misuse, the American Academy of Pediatrics (AAP) has published its first clinical guidelines on opioid prescriptions for children with acute pain. 

Presented at the Academy's Annual meeting last month, the guidelines provide a comprehensive, evidence-based approach to help clinicians treat pediatric pain safely and effectively while minimising the risk of addiction and overdose. The AAP’s recommendations aim to standardise pain management practices across various medical specialities and settings.

 

Summary of Findings:

 

The AAP’s guidelines emphasise starting opioid treatment at the lowest possible dose based on age and weight, using immediate-release formulations, and limiting prescriptions to no more than a five-day supply. Exceptions may apply in cases of trauma or surgery requiring extended pain management. 

 

The guidelines also recommend against using opioids as a sole treatment strategy, advocating for a multimodal approach combining opioids with non-opioid medications like acetaminophen and NSAIDs, as well as non-pharmacological interventions such as ice, heat, nerve stimulation, relaxation techniques, and music therapy.

 

The AAP further recommends the restriction of codeine and tramadol in children under 12 and in teens with obesity, obstructive sleep apnea, or severe lung disease. Additionally, these drugs should be avoided in children under 18 who have undergone tonsillectomy or adenoidectomy, as well as in breastfeeding mothers.

 

Other recommendations include exercising caution when prescribing opioids to children or teens taking other sedating medications, like benzodiazepines, and coordinating with other healthcare providers when managing patients with preexisting chronic pain.
 

Click to access full Key Action Statement Table on AAP 


 

The guidelines aim to reduce the underprescription of opioids, particularly in non-White and socioeconomically disadvantaged children, by introducing objective criteria for opioid use. They encourage clinicians to prioritise patient-reported pain levels and avoid dismissing pain complaints, which can contribute to inequities in pain management.

 

These recommendations are supported by varying levels of evidence, including randomised controlled trials, observational studies, and expert opinion, where data is limited. The AAP hopes these standardised guidelines will improve pain management while reducing the risks associated with opioid prescriptions in children.

 

Access the original research article

Hadland, S. E., Agarwal, R., Raman, S. R., Smith, M. J., Bryl, A., Michel, J., Kelley-Quon, L. I., Raval, M. V., Renny, M. H., Larson-Steckler, B., Wexelblatt, S., Wilder, R. T., & Flinn, S. K. (2024). Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings: Clinical Practice Guideline. Pediatrics, e2024068752. Advance online publication. https://doi.org/10.1542/peds.2024-068752

 

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