title: Opioid withdrawal signs and symptoms in children: frequency and determinants.
abstract: OBJECTIVE
  The purpose of this study was to, in a pediatric population, describe the frequency of opioid withdrawal signs and symptoms and to identify factors associated with these opioid withdrawal signs and symptoms.
  
  
  BACKGROUND
  Opioids are used routinely in the pediatric intensive care population for analgesia, sedation, blunting of physiologic responses to stress, and safety. In children, physical dependence may occur in as little as 2-3 days of continuous opioid therapy. Once the child no longer needs the opioid, the medications are reduced over time.
  
  
  METHODS
  A prospective, descriptive study was conducted. The sample of 26 was drawn from all patients, ages 2 weeks to 21 years admitted to the Children's Hospital of Richmond pediatric intensive care unit (PICU) and who have received continuous infusion or scheduled opioids for at least 5 days. Data collected included: opioid withdrawal score (WAT-1), opioid taper rate (total dose of opioid per day in morphine equivalents per kilogram [MEK]), pretaper peak MEK, pretaper cumulative MEK, number of days of opioid exposure prior to taper, and age.
  
  
  RESULTS
  Out of 26 enrolled participants, only 9 (45%) had opioid withdrawal on any given day. In addition, there was limited variability in WAT-1 scores. The most common symptoms notes were diarrhea, vomit, sweat, and fever.
  
  
  CONCLUSIONS
  For optimal opioid withdrawal assessments, clinicians should use a validated instrument such as the WAT-1 to measure for signs and symptoms of opioid withdrawal. Further research is indicated to examine risk factors for opioid withdrawal in children.
authors.affiliation: Division of Pediatric Palliative Care, Children's Hospital of Richmond at VCU, Virginia Commonwealth University Medical Center, 1250 East Marshall Street, Richmond, VA 23298, USA. Electronic address: dfisher@mcvh-vcu.edu.
authors.forename: Deborah
authors.initials: D
authors.lastname: Fisher
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Grap
authors.forename: Janet B
authors.initials: JB
authors.lastname: Younger
authors.forename: Suzanne
authors.initials: S
authors.lastname: Ameringer
authors.forename: R K
authors.initials: RK
authors.lastname: Elswick
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D010146:Pain / Q000188:drug therapy; D011446:Prospective Studies; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000453:epidemiology; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Child; Critical care; Opioid analgesia; Opioid taper; Opioid withdrawal