What medication can be given to pediatric patients for abdominal pain?

Medications for Abdominal Pain in Pediatric Patients

Pain medication should be provided to pediatric patients with abdominal pain and should not be withheld while awaiting diagnosis, as it does not mask symptoms or affect diagnostic accuracy. 1, 2

First-Line Medications

• For mild to moderate abdominal pain, oral nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen should be used if no contraindications exist 2, 3
• Acetaminophen is an appropriate alternative for mild to moderate pain, especially when NSAIDs are contraindicated 2, 4
• For severe pain, intravenous opioid analgesics titrated to effect are recommended 1, 2

Route of Administration Considerations

• The intravenous route allows for rapid pain relief and medication titration for severe pain 1
• Oral administration is appropriate for mild to moderate pain when the patient has no contraindications to receiving oral medications 1
• Intramuscular route is less preferred as it does not allow for medication titration and causes pain at the injection site 1
• Alternative routes such as intranasal, transdermal, and inhaled routes should be considered when appropriate and may offer rapid relief 1

Special Considerations for Abdominal Pain

• Administration of pain medication has been demonstrated to preserve the ability to assess patients with abdominal pain and should not be withheld 1, 2
• Pain medication can make children more comfortable and aid in diagnosis by allowing better examination and diagnostic testing 2
• For suspected appendicitis, pain control does not affect diagnostic accuracy 1
• In cases of confirmed pancreatitis, pain management should be part of supportive care along with IV fluids and bowel rest as needed 2

Dosing and Administration

• Pain medication should be provided on an around-the-clock basis for anyone in whom moderate pain is anticipated 1
• When discharged, patients should receive detailed instructions regarding analgesic administration, including dose and duration of use 1
• Administration of analgesics should be as painless or pain-free as possible 1

Common Pitfalls to Avoid

• Do not withhold pain medication while awaiting diagnosis - this outdated practice is not supported by evidence and can unnecessarily prolong patient suffering 1, 2
• Avoid intramuscular injections when possible, as they cause pain at the time of delivery and for days afterward 1
• Do not assume that pain management will mask symptoms or cloud mental status, preventing adequate assessment and diagnosis 1
• Neonates and young infants require adequate pain prophylaxis for procedures and pain relief as appropriate, but are often undertreated 1

By following these evidence-based recommendations for pain management in pediatric patients with abdominal pain, clinicians can provide effective relief while maintaining diagnostic accuracy and improving the overall care experience.