Oral analgesic dosing guidelines for children
Children's Inpatient Management of Pain Service (ChIMPS)
Paediatrics at the Nuffield Department of Anaesthetists
'PANDA' Guidance for Prescribing Pain relief in Children
NB Doses based on weight should be used to avoid inadvertant under or overdose
Paracetamol
Route
|
Dose
|
Frequency
|
Max per 24 hours
|
| Oral/PR |
Weight up to 50kg 15mg/kg |
4 times a day (6 hourly) |
Neonates: 60 mg/kg Infants/children: 75 mg/kg |
|
Greater than 50kg 1g |
4g |
||
| IV |
Neonates & infants up to 10 Kg 10 mg/kg |
3 times a day (8 hourly) |
30 mg/kg |
|
10 kg to 50 kg 15 mg/kg |
4 times a day (6 hourly) |
60 mg/kg |
|
|
Greater than 50 Kg 1g |
4g |
Notes: Prescribe regularly for persistent or postoperative pain. Review requirements at 5 days.
Ibuprofen
Route
|
Dose
|
Frequency
|
Max per 24 Hours
|
| Oral |
1-2 months 5mg/kg |
4 times a day (6 hourly)
|
15mg/kg Review at 3 days |
|
3 months up to 40 kg 10 mg/kg |
40mg/kg | ||
|
Greater than 40 kg 400 mg |
1.6 g |
Notes: Prescribe regularly for persistent or postoperative pain. Review requirements at 5 days (3 days if 1-2months).
Caution with renal impairment, asthma and low platelets (oncology patients), cardiovascular disease.
If possible administer with food.
Only prescribe one NSAID at a time.
Diclofenac
Route |
Dose |
Frequency |
Max per 24 hours |
| Oral/PR |
6 months up to 50 kg 1 mg/kg |
Max 3 times a day (8 hourly) (PR route: 12.5, 25 and 50 mg suppositories available. Prescribe one of these suppository doses as close to 1 mg/kg with a dose interval of 8 -12 hourly to give up to a total of 3 mg/kg a day) |
3mg/kg |
|
Greater than 50 kg 50 mg |
150mg |
Notes: Oral preparation only available as 50mg tablets. Do not cut suppositories.
Prescribe regularly for persistent or postoperative pain. Review requirements at 5 days.
Caution with renal impairment, asthma and low platelets (oncology patients), cardiovascular disease.
If possible administer with food. Only prescribe one NSAID at a time.
Oral Liquid Morphine (Oramorph)
Indication
|
Dose
|
Frequency
|
|
Mild to moderate pain (Take home dose) |
100 micrograms/kg |
4 times a day as required (6 hourly) |
|
Moderate to severe pain (Inpatient dose) |
Neonate up to 3 months 100 micrograms/kg |
3 to 4 hourly as required |
|
3 months up to 1 year 200 micrograms/kg |
||
|
Greater than 1 year 300 micrograms/kg |
Notes: Opioids are contraindicated in children with OSA (Obstructive sleep apnoea), sleep apnoea or breathing problems.
Antiemetics
Drug
|
Dose (route)
|
Frequency
|
| Ondansetron |
100 to 200 micrograms/kg (IV/PO) Up to 4mg maximum per dose |
8 hourly as required |
| Cyclizine |
1mg/kg (IV/PO) Up to 50mg maximum per dose |
8 hourly as required |
| Dexamethasone |
150 micrograms/kg (IV) Up to 8mg maximum per dose |
Single dose only |