A plan for tapering opioids should be developed to minimize withdrawal symptoms in children receiving opioids for five or more days, according to a clinical report from the American Academy of Pediatrics (AAP) published online Aug. 18 in Pediatrics.
Adam C. Adler, M.D., from Texas Children’s Hospital in Houston, and colleagues address screening for symptoms of iatrogenic opioid withdrawal as well as mechanisms for opioid withdrawal prevention.
The authors note that the signs and symptoms associated with withdrawal in the pediatric population are relatively consistent, with the primary manifestation often being neuropsychiatric symptoms. Commonly seen physiologic changes include increased muscle tone, nausea, vomiting, and diarrhea.
Withdrawal symptoms can be experienced with opioid administration of five or more days; providers should consider preemptively tapering opioids if prescribing opioids for five or more days. A plan to taper the opioid while minimizing withdrawal symptoms should be developed; the plan should include patient support structure and be guided by the patient’s primary care physician.
Behavioral therapy may be a useful part of any weaning program. For patients with ongoing analgesia needs, nonopioid analgesics can be beneficial and can reduce opioid requirements. Physical or occupational therapy should form part of the treatment plan.
Common pitfalls in tapering opioids include a schedule that is too rapid, failure to reassess and individualize the schedule, or inadequately accounting for analgesic needs. Weaning can be complicated by nonrecognition of withdrawal symptoms or attribution of unrelated symptoms to withdrawal.
“Prescription opioid use is prevalent in both pediatric inpatient and outpatient settings. Abrupt discontinuation of opioids can lead to drug-specific withdrawal symptoms,” the authors write. “For patients receiving prolonged opioid therapy (more than five days), it is best to develop a plan to taper the opioid therapy while minimizing withdrawal symptoms.”
More information:
Adam C. Adler et al, Recognition and Management of Iatrogenically Induced Opioid Dependence and Withdrawal in Children: Clinical Report, Pediatrics (2025). DOI: 10.1542/peds.2025-073169
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Guidance released for tapering of opioids to prevent withdrawal in children (2025, August 19)
retrieved 19 August 2025
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