This AAP Clinical Practice Guideline, “Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings: Clinical Practice Guideline”, assists pediatricians with the diagnosis and management of acute pain. Tools and resources are available to aid with early diagnosis and intervention.
This is the first Clinical Practice Guideline from the American Academy of Pediatrics outlining evidence-based approaches to safely prescribing opioids for acute pain in outpatient settings. This guideline is written for pediatricians and other pediatric health care providers (PHCPs) who prescribe opioids to children and adolescents under age 21 in outpatient settings.
Central goals
- To aid clinicians in understanding when opioids may be indicated to treat acute pain in children and adolescents
- To minimize risks, including opioid use disorder, poisoning, and overdose
- To alleviate disparate pain treatment for 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, geographical location, and other factors which are discussed.
7 key concepts to remember from the Clinical Practice Guideline
Please refer to the AAP Clinical Practice Guideline for specific key action statements.
- Prescribe non-opioid medications and recommend non-pharmacologic modalities.
- Utilize your state’s prescription drug monitoring program.
- Prescribe immediate release formulations, at the lowest age or weight appropriate dose, for the shortest possible duration (5 days or less).
- Avoid codeine or tramadol, in general*.
- Exercise caution when prescribing opioids to those taking benzodiazepines or sedating medications.
- Provide naloxone and teach when and how to use it.
- Educate about safe medication storage and share safe disposal locations.
*May use codeine or tramadol in children age 12+ years, except for those with obesity, obstructive sleep apnea, severe lung disease, breastfeeding, and/or s/p tonsillectomy or adenoidectomy.
When & How Opioids Can Be Prescribed to Children and Teens
Lead author of the Clinical Practice Guideline, Dr. Scott Hadland, offers details on the key recommendations, which are designed to keep children safe while treating acute pain. The guideline includes prescribing the overdose reversal medication naloxone alongside any opioid prescription.
Professional Tools & Resources
Get Involved
Section on Adolescent Health
This section provides a forum for pediatricians interested in the health care of adolescents and enables members to meet for the purpose of discussion and development of ideas and programs which will improve the health and care of young people.
Section on Hospital Medicine
This section is continuously seeking to improve quality of care, serving the highest priority needs of our members, and advancing the profession of pediatric hospital medicine (PHM) through leadership and advocacy.
Section on Emergency Medicine
This section aims is to sustain, develop, and promote the delivery of optimal emergency care for acutely ill and injured children.
Section on Surgery
The Section on Surgery provides programming on state-of-the-art techniques and information for pediatric surgeons and makes recommendations for educational programs, policy statements and other matters relating to the surgical care of pediatric patients.
Council on Quality Improvement and Patient Safety
The Council on Quality Improvement and Patient Safety is focused on innovations and activities supporting the integration of policy and practice, education, advocacy and implementation around the topic areas of quality improvement and patient safety.