Opioids for Pain Management in Children: New American Academy of Pediatrics Recommendations

Even though opioids in dentistry are essential for many types of dental operations and during the post-extraction period, these medicines, in some cases, may be dangerous for young patients' organisms. Thus, in 2023, the American Dental Association (ADA) published a guidance recommending restricting the use of codeine and tramadol for pain relief in children. These limitations have also been supported by FDA recommendations since 2017.

Instead of the mentioned medicines, the ADA suggested using their non-opioid analogs, such as acetominaphin and NSAIDS.

However, recently, the American Academy of Pediatrics (AAP) released another guidance that allows using of opioids when it's necessary for relieving acutely worsened pain, along with nonpharmacologic therapies and non-opioid medications.

The ADA will likely align its recommendations with AAP conclusions shortly, considering the latter are entirely evidence-based, so let's review this guide closely.

How should doctors use opioids?

According to AAP, doctors must always start with the lowest possible age- and weight-appropriate doses unless the patient has some severe trauma or has had serious surgery. However, codeine and tramadol should not be prescribed for patients younger than 12 years. Additionally, doctors must take into consideration unique patients' conditions – that these medicines are contradicted for people 12-18 years old if they have obesity, obstructive sleep apnea, or severe lung disease because these substances may aggravate their health.

AAP guidance also contains a recommendation that opioid prescribing should be combined with naloxone to prevent opioid overdose. In this case, doctors must provide the patients and their families with appropriate and understandable instructions on what to do in case of overdose.

The Importance of Drug Мariability

AAP recommendations clearly say that opioids should not be prescribed as a monotherapy. This option should be applied only in severe cases. Instead, both ADA and AAP guidelines recommend non-opioid NSAIDs as first-line medications due to their safety and effectiveness.

Still, an opioid decline may leave children from underserved socioeconomic areas without a proper way to manage their acute pain.