Pediatricians Release New Guidelines for Prescribing Opioids to Children

Recommendations suggest there is still a use for the highly-addictive painkillers among children, if they are prescribed correctly and carefully.

Doctors are being urged by a leading pediatric organization to consider using medications that are less addictive than opioids to help children handle pain. However, the group indicates that there remains a place for the powerful pain medications to be used among some children.

The American Academy of Pediatrics (AAP) published new guidelines in the medical journal Pediatrics on September 30, calling on doctors to treat severe pain in children and teens with a multifaceted approach, including non-drug therapies and non-narcotic drugs, as well as using opioids when needed.

Health experts have long criticized the rampant prescribing of opioids among children and teens. Early prescribing can often have a detrimental effect on adolescents, and lead to an increase in abuse and misuse, as well as addiction.

This is the first clinical practice guideline issued by AAP, the largest association of pediatricians in the U.S., which is dedicated to improving the health of children. The recommendations offer evidence-based approaches for doctors to safely prescribe opioids for pain among children and adolescents, indicating that the goal is to help doctors understand when opioid painkillers are needed in children and teens, and how to effectively use the powerful drugs to reduce the risks.

Pediatric Opioid Prescribing Guidelines

Research published by the Children’s Hospital of Philadelphia last year indicated more than half of all child poisoning deaths involve opioid painkillers. That number has increased significantly since 2005, when they accounted for less than one-quarter of child drug poisoning deaths.

Data has long linked the opioid overdose epidemic to lax doctor prescribing habits. For that reason, the new AAP guidelines call for increased caution and other pain treatment methods when the drugs are being considered for children and teens.

Specifically, the recommendations indicate that doctors should treat severe pain with a “multimodal approach.” This includes the use of non-drug therapies including physical therapy and acupuncture, non-opioid medications like Tylenol and Advil, and the use of opioid medications only when needed.

The guidelines call for doctors not to prescribe opioid painkillers as the only therapy for children and teens with acute pain. Doctors should also provide the overdose reversal medication Narcan, together with information for the safe storage and disposal of opioids.

The AAP also calls on doctors to prescribe immediate-release opioid formulations and start with the lowest appropriate dose for the child’s age and weight. Doctors should only provide a five-day supply or less, except when the pain is trauma or surgery related, and expected to last longer than five days, the guidelines state.

According to the AAP guidelines, doctors should not prescribe any opioids for patients under 18 who receive tonsillectomies or adenoidectomies. Additionally, the opioids codeine and tramadol should never be prescribed for patients younger than 12 years old, as well as children and adolescents who are older than 12 and obese, have sleep apnea, or suffer from severe lung disease.

Caution should also be used when prescribing opioids to adolescent patients who are taking sedative medications, the guidelines state.

Doctors are also being called upon to partner with other physicians who specialize in pain care to make an appropriate treatment plan for children and teens. While they acknowledge the overuse of opioids is still a serious risk, the AAP expressed concern that many doctors are now avoiding the drugs entirely, even when they could prove useful.

“Clinicians’ approaches to pain management have changed dramatically in the last 2 decades. At the turn of the century, prevailing narratives on pain treatment supported the liberal use of opioids,” the researchers wrote. “As prescription opioids increasingly became involved in US overdose deaths, the proverbial pendulum swung widely, and many clinicians and health systems inflexibly began refusing to offer opioids for pain—even in cases when these prescriptions were likely indicated.”