Analgesic |
Route
|
Dose
|
Maximum daily dosing
|
Notes/onset of action
|
Sucrose (any concentration eg 24%, 33%)
|
PO
|
Preterm (corrected age 32-40/40 weeks): 02-0.5 mL per procedure
<1 month: 0.5-1 mL per procedure
1-18 months: 1-2 mL per procedure
|
Preterm: max 2.5 mL/day
<3 months: max 5 mL/day
≥3 months: max 10 mL/day
|
Children 0-18 months (most effective in children
<6 months)
Provide one-quarter of dose to anterior tongue 2 minutes prior to painful procedure, with dummy if available. Continue in small increments as required
Analgesic effect may last 5-8 minutes from administration
|
Paracetamol
|
PO
|
15 mg/kg (max 1 g) 4-6 hourly
|
Birth-1 month: 60 mg/kg/day
>1 month: 90 mg/kg/day (max 4 g) for severe pain for max 48 hours, then 60 mg/kg/day subsequently
|
Onset of action 30 minutes
Oral route is preferred
Dose on ideal body weight
Administer commercial syrup carefully as available in several concentrations
|
PR
|
15-20 mg/kg (max 1 g) 6 hourly
|
<1 month: 60 mg/kg/day
>1 month: 90 mg/kg/day (max 4 g) for max 48 hours, then 60 mg/kg/day subsequently
|
If not tolerated orally
Rectal absorption can be delayed and erratic
Dose on ideal body weight 125 mg, 250 mg, 500 mg suppositories available
PR medication should be avoided in immunocompromised children
|
IV
|
<1 month:
10 mg/kg 6 hourly
>1 month: 15 mg/kg (max 1 g) 6 hourly
|
<1 month: 40 mg/kg/day
>1 month: 60 mg/kg/day (max 4 g)
|
Onset of action 5-10 minutes
If PO/PR not tolerated
More expensive
Dose on ideal body weight
Dose (mg) and volume (mL) errors have caused significant overdoses in young children
|
Ibuprofen
|
PO
|
>3 months: 10 mg/kg (max 400 mg) 6-8 hourly with food
|
30 mg/kg/day (max 2.4 g)
|
Onset of action 30 minutes
Precautions include renal impairment, dehydration, bleeding, anticoagulant use
Asthma is not a contraindication
Administer commercial syrup carefully as available in several concentrations
|
Oxycodone
|
PO
|
1–12 months: 0.05-0.1 mg/kg 4 hourly >12 months: 0.1-0.2 mg/kg (adult dose 5-10 mg) 4 hourly
|
1-12 months: max 0.6 mg/kg/day
>12 months: max 1.2 mg/kg/day
|
Onset of action 10-30 minutes
Higher/more frequent dosing can be used in hospital settings
For short term use
Do not prescribe for outpatient use if no clear diagnosis
|
Morphine
|
IV/SC
|
<1 month: 0.025 mg/kg, repeat as needed
1-12 months: 0.05 mg/kg
>12 months: up to 0.2 mg/kg (max 5-10 mg)
|
Cumulative maximum:
<1 month: 0.1 mg/kg 4-6 hourly (max 0.6 mg/kg/day)
1-12 months: 0.1 mg/kg 2-4 hourly (max 1.2 mg/kg/day)
>12 months: 0.2 mg/kg 2-4 hourly (max 2.4 mg/kg/day)
|
Rapid onset, peak effect 5-10 minutes
Higher/more frequent dosing can be used in hospital settings
|
Fentanyl
|
Intra-nasal
|
>12 months: 1.5 microg/kg (max 100 microg) for first dose
0.75 microg/kg for subsequent doses after 10 minutes
|
Total dose of 3 microg/kg/day
|
Rapid onset (5 minutes)
Divide dose between nostrils using atomiser
Consider alternative ongoing analgesics after second dose
Not recommended
<12 months of age
|
Tramadol
|
PO/IV
|
>12 years 0.5-1 mg/kg (max 100 mg) 6 hourly
|
4 mg/kg/day (max 400 mg)
|
Onset of action 30-60 minutes
Can give up to 2 mg/kg if no risk of sleep apnoea/risk factors for respiratory depression
Avoid in epilepsy (lowers seizure threshold)
Avoid in young people on SSRIs (risk of serotonin syndrome)
|