Opioid withdrawal signs and symptoms in children: Frequency and determinants

• Published in: Heart & lung Vol. 42; no. 6; pp. 407 - 413
• Main Authors: Fisher, Deborah, PhD, RN, Grap, Mary Jo, PhD, RN, FAAN, Younger, Janet B., PhD, RN, Ameringer, Suzanne, PhD, RN, Elswick, R.K., PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-11-2013; Elsevier Science Ltd
• Subjects: Adolescent; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Cardiovascular; Child; Child, Preschool; Critical Care; Drug therapy; Female; Humans; Infant; Intensive care; Intensive Care Units, Pediatric; Male; Narcotics; Opioid analgesia; Opioid taper; Opioid withdrawal; Pain - drug therapy; Pediatrics; Prospective Studies; Pulmonary/Respiratory; Risk Factors; Side effects; Substance Withdrawal Syndrome - diagnosis; Substance Withdrawal Syndrome - epidemiology; Withholding Treatment; Young Adult; United States > US; Critical care; Opioid taper; Opioid analgesia; Child; Opioid withdrawal
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2013.07.008

Abstract Objectives The purpose of this study was to, in a pediatric population, describe the frequency of opioid withdrawal signs and symptoms and to identify factors associated with these opioid withdrawal signs and symptoms. Background Opioids are used routinely in the pediatric intensive care population for analgesia, sedation, blunting of physiologic responses to stress, and safety. In children, physical dependence may occur in as little as 2–3 days of continuous opioid therapy. Once the child no longer needs the opioid, the medications are reduced over time. Methods A prospective, descriptive study was conducted. The sample of 26 was drawn from all patients, ages 2 weeks to 21 years admitted to the Children's Hospital of Richmond pediatric intensive care unit (PICU) and who have received continuous infusion or scheduled opioids for at least 5 days. Data collected included: opioid withdrawal score (WAT-1), opioid taper rate (total dose of opioid per day in morphine equivalents per kilogram [MEK]), pretaper peak MEK, pretaper cumulative MEK, number of days of opioid exposure prior to taper, and age. Results Out of 26 enrolled participants, only 9 (45%) had opioid withdrawal on any given day. In addition, there was limited variability in WAT-1 scores. The most common symptoms notes were diarrhea, vomit, sweat, and fever. Conclusions For optimal opioid withdrawal assessments, clinicians should use a validated instrument such as the WAT-1 to measure for signs and symptoms of opioid withdrawal. Further research is indicated to examine risk factors for opioid withdrawal in children.