Immediate-release oral opioids used for postoperative pain in children <50 kg

Drug	Oral dose	Comments
Oxycodone	≤6 months of age: 0.025 to 0.05 mg/kg orally every 4 to 6 hours >6 months of age: 0.05 to 0.1 mg/kg orally every 4 to 6 hours, maximum 5 to 10 mg orally	Available as a tablet or oral solution (1 mg/mL); concentrated solution (20 mg/mL) should not be used in opioid naïve children
Hydromorphone	0.03 mg/kg orally every 4 to 6 hours	Available as a tablet or oral solution (1 mg/mL)
Morphine	0.3 mg/kg orally every 4 to 6 hours, maximum 15 mg	Available as tablet or oral solution (2 mg/mL)
Hydrocodone	0.1 mg/kg every 4 hours	Not recommended due to availability only in combination with acetaminophen or ibuprofen

Initial doses should be at the low end of the dose range, with doses increased incrementally as needed.
Regularly scheduled dosing is occasionally required in hospitalized patients. Regularly scheduled dosing should not be initially prescribed for patients with neurologic disorders, developmental delay, a history of apnea, or for infants, without intensified monitoring. For ambulatory patients, opioids should usually be prescribed on an as needed basis.
For children ≥50 kg, use adult dosing.
For further information refer to UpToDate content on management of perioperative pain in children.

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