By: Amy Bryl, MD, FAAP
Whether your child had
surgery, an injury or is living with a
chronic condition or illness, there are ways to help manage their pain. Sometimes, the doctor or dentist will prescribe opioid medication for more severe pain.
If your child receives an opioid prescription, there are safety tips parents should follow. For example, an opioid medicine should not be used alone. Instead, it should be used along with other pain relievers for more severe pain and/or other non-medication strategies for managing pain. It's also important to know how to store and dispose of unused opioid medications safely, and how to respond to an opioid overdose.
Here is what to know about safely managing your child's pain and minimizing side effects.
Use the right remedies for your child's pain.
Various types of medication can help when a child is in pain. But it is often safest and most effective to use medication in combination with other remedies when a child has moderate or severe pain.
Your pediatrician, dentist or health care provider can recommend what will work best for your child. This can depend on the type of pain, what is causing it, how severe it is, and their age.
For mild pain, they might recommend ice packs, heat, elevation and rest; distraction (for example, reading books, playing games, watching movies or listening to music) and walking or stretching as recommended.
For mild or moderate pain, they might also recommend over-the-counter pain medication (for example,
acetaminophen or
ibuprofen).
For severe pain, they might also prescribe opioid medicine.
Have a hands-on approach to prescription opioids.
If your child receives a prescription for opioid medication, there are ways to help make the experience as safe as possible.
Follow the instructions. Make sure your child takes the medication as prescribed and for the least possible time. Most opioids for children are prescribed at the lowest dose possible and for a very short time—often 5 days or less. Remember to ask when your child can safely take their other prescription medications, over-the-counter medications and vitamins or supplements.
Pay close attention when giving your child their medication. Keep track of how much medicine is in the container. This helps you confirm that they are taking the right amount each time. When giving liquid medicine, use the dosing tool that comes with the medicine or that the doctor or pharmacist tells you to use. If a dosing tool is not provided with the medicine, ask the pharmacist or doctor to give you one.
(See How to Use Liquid Medicines for Children.)
Talk to your child about the risks of becoming dependent on opioids. Explain that carefully following the instructions for the opioid prescription can help avoid or reduce dependency on opioids. Signs of dependency can include
taking opioids for reasons other than pain relief. Other warning signs are mood changes, breathing, sleepiness and confusion.
Keep track of how the prescription is used and store all medications in a locked location that is out of reach of children and teens. Close monitoring can help prevent your child from taking too much medication. It also prevents others from taking medications that are not prescribed for them.
What to know about codeine and tramadol
Codeine is a medication to treat pain and cough. Tramadol is a medication to treat pain. Both medicines have risks of slowed or difficult breathing and death, especially in children. Codeine and tramadol should not be prescribed for children younger than 12 years. These medicines should not be used in children under age 18 years to treat pain after
surgery to remove the tonsils or adenoids. And codeine and tramadol should not be prescribed for youths between ages between 12 and 18 years of age who have obesity, obstructive sleep apnea or severe lung disease. Also, do not used these medications while breastfeeding.
Have naloxone to reverse an opioid overdose.
If someone in your home takes opioids for any reason, it's a good idea to have naloxone, too. Naloxone is a life-saving medication that can quickly reverse an opioid overdose. It is available as a nasal spray that is easy to administer.
(See What to Know About Fentanyl & Using Naloxone for Opioid Overdose.) Here's what to know.
There are three ways to get naloxone:
Through a prescription from your doctor or pharmacist.
Over the counter at major pharmacies or online retailers.
From a community organization or local health center, often for little to no cost.
Naloxone is safe for anyone who may or may not have overdosed on opioids. If given to someone who is NOT having an overdose,
naloxone usually has no side effects and is safe to give. Parents should be aware that a child coming out of an opioid overdose may experience breakthrough pain and/or agitation.
Opioid overdose is a life-threatening emergency that requires immediate medical attention. Call 911 immediately—and if available, provide naloxone—if a person exhibits any of the following symptoms:
Face is extremely pale and/or feels clammy to the touch
Body goes limp
Fingernails or lips have a purple or blue color
They start vomiting or making gurgling noises
They cannot be awakened or are unable to speak
Their breathing or heartbeat slows or stops
Get rid of unused opioids right away.
Follow safe
disposal instructions for unused or expired medications. Ideally, you can bring them to a designated
drug take-back location. If this is not an option, some specific medications such as opioids and pain medications can be flushed.
Do not throw opioids into the trash. Refer to the Food and Drug Administration flush list.
If you have unused medication that
cannot be flushed:
Combine it (liquid or pills) with dirt, cat litter, used coffee grounds or another undesirable substance.
Put the mixture into a sealed container.
Dispose of the container in your household trash.
Be sure to
remove personal information, including the prescription (Rx) number from prescription bottles before disposing of them.
Remember
Opioids are prescribed to help control pain after a child has surgery or for other reasons. Most children who receive an opioid prescription do not develop an opioid use disorder or have an overdose. Taking precautions when handling prescription opioids can help keep your child and others safe.
More information
About Dr. Bryl
 Amy Bryl, MD, FAAP, is Associate Clinical Professor of Pediatrics at the University of California San Diego and Director of Quality for Children's Specialists of San Diego and the Division of Emergency Medicine at Rady Children's Hospital San Diego. She was the implementation scientist on the recently published American Academy of Pediatrics Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings: Clinical Practice Guideline.
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