Opioid Withdrawal Signs and Symptoms in the Pediatric Patient during Opioid Tapering

SIGNS AND SYMPTOMS OF OPIOID WITHDRAWAL IN THE PEDIATRIC PATIENT DURING OPIOID TAPERING By Deborah Fisher, PhD, RN, CS, PNP-BC, CPON A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2012 VCU Chair: Mary Jo Grap, PhD, RN, FAAN Professor, Adult Health and Nursing Systems School of Nursing 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 two to three days of continuous opioid therapy. Once the child no longer needs the opioid, the medications are reduced over time. A review of the literature revealed that the majority of the published studies used either a neonatal opioid assessment tool or no assessment tool. A subsequent international survey of pediatric providers found a wide range of opioid tapering practices and sporadic use of opioid withdrawal instruments to guide practice. Since tapering routines vary among practitioners, it is not uncommon to see signs and symptoms of opioid withdrawal. A prospective, descriptive study was conducted to describe the frequency of opioid withdrawal signs and symptoms and to identify factors associated with these opioid withdrawal signs and symptoms. The sample of 25 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. 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. 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.