A team of medical professionals led by a pediatric surgeon at Children’s Hospital Los Angeles has developed a set of guidelines for safe pain management in children and adolescents, including the use of opioids.
Dr. Lorraine Kelley-Quon and her colleagues outline 20 guidelines in their effort, which was published in JAMA Surgery.
“Many people are aware that there’s an opioid epidemic, but when I talk about my work, people are surprised to hear that it impacts children,” Kelley-Quon said. “Opioids can be very effective in pain management following pediatric procedures, but we need to work with the medical community to ensure they are used safely and judiciously.”
Kelley-Quon created a multidisciplinary group that included specialists in pediatric surgery, pediatric anesthesia, and addiction science, and included other key stakeholders representing nursing, physician assistants, surgery trainees, and family advocates. The team conducted an extensive review of scientific and medical publications, and constructed the guidelines together.
“Opioid prescribing doesn’t just impact what a pediatric surgeon does,” she said. “Nurses and other medical care providers are involved in pain management discussions with patients and their families, so we wanted their input as well.”
The team came up with three basic tenets, into which all the guidelines fall. First is a recognition that misuse of prescription opioids is a problem to be taken seriously when caring for children and adolescents.
Second is to acknowledge there are many non-opioid medications that have excellent data supporting their use for children who require surgery. Finally, health care providers must educate patients and families before and after surgery about what an opioid is, what the risks are, and how they should be safely stored and disposed of.
“With these guidelines, we didn’t want to suggest that opioids should never be used,” Kelley-Quon said. “Instead, we wanted to impart the idea that they need to be used in a thoughtful way.”
According to the U.S. Centers for Disease Control, approximately 9% of teens aged 15-19 report receiving an opioid prescription in 2018. This age group is of concern because prescription medications can be used recreationally and shared with friends. In addition, research shows that death due to opioid overdose is on the rise for all age groups.
The guidelines can be viewed here.