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Recognition and Management of Iatrogenically Induced Opioid Dependence and Withdrawal in Children: Clinical Report

Adam C Adler1, Linda B Siegel2, Robert T Wilder3

  • 1Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.

Pediatrics
|August 17, 2025
PubMed

Insights

Pediatric opioid use can lead to physiological dependence and iatrogenic withdrawal within days. This report addresses screening and prevention strategies for opioid withdrawal in children, as adult guidelines are insufficient.

Area of Science:

  • Pediatric pharmacology
  • Pain management
  • Neonatal abstinence syndrome

Background:

  • Opioids are commonly prescribed for pediatric pain management.
  • Around-the-clock opioid administration can lead to physiological dependence in as little as 5 days.
  • Existing opioid withdrawal guidelines are primarily for adults, often with substance use disorders, leaving a gap in pediatric care.

Purpose of the Study:

  • To summarize existing literature on iatrogenic opioid withdrawal in children.
  • To provide guidance on screening for symptoms of opioid withdrawal in pediatric patients.
  • To outline mechanisms for preventing opioid withdrawal in children.

Main Methods:

  • Literature review of existing studies on pediatric opioid use and withdrawal.
  • Analysis of definitions and diagnostic criteria for opioid dependence and withdrawal.
  • Synthesis of information on clinical presentation and management strategies.

Main Results:

  • Physiological opioid dependence can occur rapidly in children with continuous opioid dosing.
  • Iatrogenic opioid withdrawal symptoms in children are variable, ranging from mild to life-threatening.
  • There is a lack of specific guidance for managing opioid withdrawal in pediatric populations.

Conclusions:

  • Healthcare providers need to be aware of the risk of iatrogenic opioid withdrawal in children.
  • Screening tools and prevention strategies are crucial for managing pediatric patients on opioids.
  • Further research and guidelines are needed to address opioid withdrawal management specifically in children.

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