Paediatric Analgesia Guidelines

The following analgesics should be considered in the management of childrens pain.

Paracetamol

Non Steroidal Anti-Inflammatory Drugs

• naproxen 5 - 10 mg/kg (max 500 mg) 12-hrly orally or PR
• ibuprofen 2.5 - 10 mg/kg (max 600 mg) 6-8hrly orally

Opioids

• codeine 0.5 - 1 mg/kg orally (as adjunct - Liquigesic-fever or Painstop- sedation)

Sucrose

Oral sucrose has been shown to reduce pain in infants less than 18 months of age during minor procedures. Sucrose may be more effective if given with a dummy as the dummy promotes non-nutritive sucking which contributes to calming.

• Maximum 2mL (0.5mL for infants below 1500 grams) administered orally for each procedure.
• Two minutes prior to a painful procedure, administer a small amount (around 0.25ml) of sucrose onto the infant's tongue. Offer a dummy if this is part of the infants care.
• Continue giving remainder of sucrose slowly during the procedure for a total dose of 2ml, until the procedure is completed.

Stock bottles of 33% sucrose are available from Royal Children's Hospital Pharmacy Department.

Note:

Sucrose is only effective if given orally. There is no effect if given via an oral or nasogastric tube.

The addition of non-nutritive sucking enhances the analgesic effect of sucrose.

Other strategies which assist in calming infants and can be used as an adjunct include; feeding (if allowed), cuddling, and wrapping.