This information is for parents of children going home from the RCH after an operation. This is a guide to help you give the medicine safely and properly. Please talk about your child's individual needs with your nurse or the ward pharmacist before you leave hospital.

• Going home after surgery, your child should only need pain relief for a week or less.
• For the first two days after going home, continue giving the pain relief medication as advised by your child's nurse, doctor or pharmacist.
• Some children may only need pain relief at home for a short time, while others will need it for much longer.
• If your child is still in quite a lot of pain after one week, or you have used all of the medication provided by the hospital pharmacist, please see your family doctor or contact the medical team who cared for your child.
• Use your child's pain and activity levels as an indication of how much and how often you give them pain relief. For example, if they are in pain and not doing much, give pain relief. If they seem happy and are active, they may not need pain relief.
• Observe your child to make an appropriate choice on when and how to reduce the amount of pain relief you give.
• It may be helpful to give the full dose before bedtime for a few days to make sure your child can sleep.
• During the day, children often don't notice pain as much if they are distracted and doing things.

How do you know when your child is in pain?

• crying
• screaming
• pulling a face
• changes in sleeping and eating patterns
• becoming quiet and withdrawn
• refusing to move
• being unable to get comfortable
• guarding the site of their surgical wound

Types of pain relief medicine

Paracetamol - also known as Panadol, Dymadon, Panamax

• Simple pain relief which is safe and effective when taken as directed on the label.
• Use the right product and dose strength for your child's age and weight.  Liquid paracetamol for children comes in different strengths for children of different ages and weights.
• Many other medicines also have paracetamol in them.  This includes many medicines for coughs, colds, sinus congestion and period pain.  If paracetamol is in a medicine, it will always be written on the label.

Ibuprofen - also known as Nurofen

• Gives effective relief from pain caused by inflammation (swelling).  Can be given at the same time as paracetamol.
• Side effects may include nausea and tummy pain.
• Must be taken with food.
• Always check medicine labels for drugs including ibuprofen.  Do not give these to your child unless advised by the doctor or surgeon.

Diazepam 

• Helps to relieve and prevent muscular spasms. Muscle spasms can be described as 'jumping' muscles. You may see the muscles contracting rapidly. If your child can describe the pain, they may describe spasms to you.
• Watch your child during activities.  Diazepam can cause drowsiness.  This can be increased if your child has oxycodone as well.
• As your child's pain improves, slowly reduce the amount of diazepam you give in the day and increase the amount of time between doses.

Tramadol 

• Opioid-like analgesia used for moderate to severe pain when paracetamol and/or ibuprofen don't give enough relief.
• Some side effects include nausea, constipation and drowsiness.
• Don't give more than the recommended dose and ALWAYS follow instructions on the label or speak to a pharmacist, doctor or nursing staff if you are unsure.
• If your child does not have a bowel motion (poo) within a period of time that is normal for them, talk to your local pharmacist for advice on a suitable laxative (medicine to relieve constipation).
• As your child's pain improves, slowly reduce the amount of tramadol you give in a day and increase the time between doses.

Oxycodone

• An opioid like analgesia used for moderate to severe pain when paracetamol and/or ibuprofen and/or tramadol don't give enough relief.
• Some side effects include constipation and drowsiness.
• Don't give more than the recommended dose and ALWAYS read the label before measuring the dose.
• If your child does not have a bowel motion within a period of time that is normal for them, talk to your local pharmacist for advice on a suitable laxative (medicine to relieve constipation).
• As your child's pain improves, slowly reduce the amount of oxycodone you give in a day and increase the time between doses.

Targin (oxycodone/naloxone)

• Targin is a controlled release product, designed to release the medication into the body in steady amounts over 12 hours.
• As the medication is released into the body over 12 hours, it is important to give this medication TWICE per day.
• Targin is a combination of two medicines - oxycodone and naloxone.
• Oxycodone is an opioid analgesic used for moderate to severe pain when paracetamol and/or ibuprofen and/or tramadol don't give enough relief.
• Some side effects of oxycodone include constipation and drowsiness.  Naloxone is used to help prevent the constipation that can be caused by the oxycodone.
• It is important for your child to swallow the medication whole so that it is released into the body in a controlled way.  If your child is unable to swallow tablets, please let the nurse, pharmacist or doctor know as this medication will not be suitable.

Other common medications your child might go home with:

Antibiotics

•  Your child may be discharged home on a short course of antibiotics to help prevent infection after surgery.
• It is important that your child completes the course of antibiotics even if they do not seem unwell or if they are feeling better.
• If your child is vomiting the antibiotic, please let your local doctor (GP) or the medical team at the RCH know.

Laxatives

•  Your child may become constipated after surgery due to the effects of pain medication and other factors, and may be discharged with some medication to help treat this.
• There are several different medications that are used to prevent and treat constipation, for example, Lactulose, Movicol and Docusate with Senna.
• If your child has had problems with constipation and/or is taking strong pain medicine, it is recommended that they are given the laxative medication until their normal bowel habits return.
• Plenty of fresh fruit, vegetables and a diet high in fibre will help.  Make sure your child drinks plenty of water.
• Most laxatives are available without a doctor's prescription.  If you run out of laxatives, you will be able to purchase more from your local pharmacy.

Anti-nausea (antiemetic) medication

•  Some children may still be nauseated (feel sick in the tummy) when they are discharged home and will require some medication to help reduce this.
• Common anti-nausea medications are metoclopramide and ondansetron.
• If your child feels sick or vomits, stop giving food for about one hour.  Then try a light diet if your child can manage it without feeling ill.
• If your child continues to vomit despite having anti-nausea medication, please call the hospital on the number listed at the end of this factsheet.

Key points to remember:

•  These medications should only be given as specified on the pharmacy label.
• If you feel your child needs pain relief more often, contact your local family doctor or the RCH.

For more information:

• Talk to your family doctor (GP), or call the ward your child stayed on  at the RCH (03) 9345 5522
• For medication related enquiries during business hours, call the ward your child stayed on and ask to speak to the ward pharmacist.  Otherwise, call the RCH Pharmacy on (03) 9345 5492
• Kids Health Info factsheet:  Pain relief for children - paracetamol and ibuprofen

Call an ambulance (000) immediately in an emergency.

Developed by The Royal Children's Hospital Pharmacy and Orthopaedics department. We acknowledge the input of RCH consumers and carers.

Reviewed August 2020.

This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.