The American Academy of Pediatrics (AAP) has issued its first clinical practice guideline on prescribing opioids for outpatient acute pain management in children, published in Pediatrics. The guideline recommends using immediate-release opioids at the lowest dose for age- and weight-appropriateness, with an initial supply of no more than 5 days unless the pain is due to trauma or surgery requiring longer treatment. Codeine and tramadol should not be prescribed to children under 12, adolescents with certain conditions, or breastfeeding patients, according to the guideline. AAP highlights the risks of opioid use disorder among youth but warns that reduced prescribing could also lead to undertreated pain. The AAP advises combining opioids with non-opioid medications like ibuprofen and nonpharmacological methods such as physical therapy. Naloxone should also be co-prescribed with opioids. Recommendations are based on clinical trials, observational studies, and expert consensus.
Informed decisions: What’s interesting is that this is the first AAP guideline that addresses pediatric pain and opioid prescribing. It remains a hot-button issue because of the staggering rates of opioid addiction and overdose in recent decades and the difficulty in defining appropriate use of opioids. At the practice level, there is no doubt a degree of variability in clinical approaches as prescribers try to balance pain management with addiction risk. Guidelines can help clinical teams—and patients and caregivers—make informed decisions.
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