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Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Safe and Effective Pain Management After Surgery for Children and Teens
A Guide for Children, Teens & Families
This education will help parents and guardians manage their child’s pain after surgery.
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From the operating room to home—your surgical team cares about your best recovery.
Your child's surgical team may include many providers, such as your surgeon, anesthesia provider, pharmacist, nurses, and therapists.
Multiple methods may be used to manage surgical pain, including medicine and non-medicine therapies. Children may also be prescribed opioids to control severe pain resulting from their operations. Patients, families, and caregivers need to know how to safely use these medications and dispose of them once they are no longer needed.
Before your child’s operation, we encourage you to review the materials on this website. If you have questions, ask your child’s surgeon.
Some over-the-counter cough cold medicine and prescription pain medicine also has acetaminophen in it.
Ask your doctor or pharmacist about using other medicine when taking acetaminophen. Talk with your doctor if these are used together.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Decrease pain, swelling, and fever
Ibuprofen (Advil®, Motrin®)
Generic brands available
Available as:
Liquid
Capsule
Tablet
Chewable tablet
Take this medicine with food. It may upset your child’s stomach.
Dosing
Medication doses are based on your child’s weight. Follow package directions for dosing. Your surgical team and pharmacist will also explain the correct dosage and timing for your child.
Use a tool meant for medications to measure a dose. Examples are:
Dosing spoon or cup
Oral syringe or dropper
If you did not get one, or need help using it, ask your pharmacist.
Ask your doctor if they will want you to alternate acetaminophen with an NSAID given at different times.
Side Effects
Side effects may occur. Check the medication label/package insert for possible side effects.
Decreases severe pain—blocks pain signals in your brain and spinal cord
Hydromorphone (Dilaudid®)
Oxycodone (OxyContin®)
Oxycodone with acetaminophen (Percocet®, Oxycet®
Morphine
Generic brands available
For opioid-related constipation, you may give your child plenty of water. Fiber-rich foods may also help. These include:
Fruits (like berries, apples, prunes, and pears)
Vegetables (like broccoli, spinach, peas, beans)
Nuts
If these methods aren’t effective, ask your surgical team about a stool softener or laxative.
Severe Pain - Opioids
Medication
Considerations
Opioids
Decreases severe pain—blocks pain signals in your brain and spinal cord
Hydromorphone (Dilaudid®)
Oxycodone (OxyContin®)
Oxycodone with acetaminophen (Percocet®, Oxycet®
Morphine
Generic brands available
For opioid-related constipation, you may give your child plenty of water. Fiber-rich foods may also help. These include:
Fruits (like berries, apples, prunes, and pears)
Vegetables (like broccoli, spinach, peas, beans)
Nuts
If these methods aren’t effective, ask your surgical team about a stool softener or laxative.
Dosing
Dosing is based on the child’s weight. Your doctor and pharmacist will determine the appropriate dose. When you take an opioid, pain control may start within 15-60 minutes. This depends on the medication. New opioid prescriptions for children and teens are usually limited. If your child’s severe pain lasts longer, call your doctor to be seen.
Side Effects
Side effects may occur. Check the medication label/package insert for possible side effects.
Prescription opioid risks include non-medical prescription opioid use, abuse, addiction, overdose (taking too much of the medication), and very slow breathing (which can lead to death). If any of these serious risks occur, stop taking the medication. Call your provider or go to the emergency room.
Your child's pain may be controlled with a combination of non-medication therapies and non-opioid medications. For complex procedures, your child’s pain plan may also include opioids. After one to several days, the need for opioids will decrease. Use the guide below to help manage your child’s pain. Children with chronic pain or a history of prolonged opioid use will have an individualized plan for postoperative pain management.
It is easier to manage pain when it is lower. Check in with your child often to assess and help control their pain before it grows.
How Intense Is My Child's Pain?
How can I help my child feel better?
Mild Pain
My child hardly notices the pain, and it does not interfere with his or her activities.
My child notices the pain and it is distracting.
He or she can still do their normal activities (sitting up, walking, standing, playing). They may occasionally grimace.
Non-medication therapies
Non-opioid, oral medications
You may give these to your child to control mild pain when needed.
Mild-to-Moderate Pain
My child’s pain is hard to ignore.
Pain is interfering with my child’s usual activities. They may be crying but can be distracted.
Non-medication therapies
Non-opioid, oral medications
You may give these to your child on a schedule rather than as needed.
Severe Pain
My child is focused on the pain and is not doing activities.
They are groaning in pain, cannot sleep, unable to do anything, crying, or difficult to comfort.
Non-medication therapies
Around-the-clock non-opioid medications
Short-acting opioids
Call your child’s surgeon if severe pain continues.
Adapted from the FLACC scale.
How can opioids be used to safely manage my child's severe pain?
Parents:
Communicate often with your child about his or her pain.
Watch your child take their prescribed medication.
Watch for adverse events or signs of non-medical prescription opioid use.
Your Child Should:
Take the lowest dose possible.
Tell your provider about any other medicines. Include ones you take without a prescription.
Exercise extreme caution if your child is taking certain medicine (see examples below). Check with the provider. Combining these with opioids can increase your child’s risks of side effects, including overdose.
antihistamines or sleep aids
sedatives or tranquilizers
anti-anxiety medicine
muscle relaxers
cough medicines containing codeine
another opioid
Never take more medication than prescribed.
Never take medicine prescribed for someone else.
Never crush pills. This can speed the rate your child’s body absorbs the opioid and cause an overdose.
If your child can’t take pills, ask your surgical team for a liquid option.
Be Prepared
Naloxone is an overdose reversal medicine. It should be prescribed anytime opioids are prescribed. If you don’t get this, ask your pharmacist.
Keep naloxone nasal spray on hand. Know when to use it. Ask your pharmacist to show you how to use it. Steps for use may also be on the package.
Remember, you can get it without a prescription (over-the-counter).
Giving Naloxone Nasal Spray:
Place tip of the nasal spray into one nostril of the person who overdosed.
Push up the plunger to spray the medicine.
Recognizing and Responding to an Opioid Overdose
Signs of an Opioid Overdose
What to Do
Lips or fingernails turn purple or blue
Vomiting
Pale or clammy face
Limp body
Small pupils
Slow or stopped breathing or heartbeat
Unconsciousness – can’t wake up or speak
Give naloxone
Call 911
Try to keep them awake and breathing
Lay the person on their side
Stay until help is there
A child can die from an opioid overdose.
See the CDC website for more information, including how to give the nasal spray:
What are the risks of my child becoming addicted to opioids?
Anyone who takes prescription opioids can become addicted. There are multiple factors for why people may become addicted.
Check to see that your child’s pain is decreasing over the days following surgery. Call your doctor if you think your child is misusing their pain medication, experiencing tolerance, or experiencing physical dependence.
For questions and resources to help you or a loved one cope with a substance use disorder, visit the Substance Abuse and Mental Health Services Administration website at samhsa.gov or call the 24-hour helpline at 1-800-662-HELP (4357).
Jessica Burgess, MD, FACS; Associate Professor; Chief, Division of Acute Care Surgery, Department of Surgery, Macon & Joan Brock Virginia Health Sciences, EVMS Medical Group at Old Dominion University
Eunice Y. Huang, MD, MS, FACS, FAAP; Professor, Vice Chair for Surgical Quality and Patient Safety, Section of Surgical Sciences; Executive Vice Chair, Department of Pediatric Surgery, Vanderbilt University Medical Center; Associate Surgeon-in-Chief & Chief Surgical Quality and Innovations Officer, Monroe Carell Jr. Children’s Hospital at Vanderbilt
Lorraine I. Kelley-Quon, MD, MSHS, FACS, FAAP; Associate Professor (Clinical Scholar), Division of Pediatric Surgery, Children's Hospital Los Angeles, Department of Surgery and Population & Public Health Sciences, Keck School of Medicine of USC
James T. O’Donnell, Pharm.D., M.S., FCP, ABCP, FACN, R.Ph; Associate Professor, Rush University Medical Center
Benedict Nwomeh, MD, MPH, FACS; Nationwide Children’s Hospital; Professor, Ohio State University College of Medicine
MaryAnn Kliethermes, Pharm.D.; Director, Medication Safety and Quality, American Society of Health-System Pharmacists®
Katie Maruyama, MSN, RN; Senior Manager, Patient Education, American College of Surgeons
Mandy Bruggeman; Senior Program Administrator, Patient Education, American College of Surgeons
ACS Surgical Patient Education Program
Ajit K. Sachdeva, MD, FACS, FRCSC, FSACME, MAMSE, Senior Vice President
Patrice Blair, DPH, Vice President
Kathleen Maruyama, MSN, RN, Senior Manager
Amanda Bruggeman, Senior Program Administrator
American College of Surgeon Patient Education Committee Members
Co-Chair Ajit K. Sachdeva, MD, FACS, FRCSC, FSACME; Senior Vice President, Division of Education, American College of Surgeons
Jessica R. Burgess, MD, FACS
David Tom Cooke, MD, FACS
Jeffrey Farma, MD, FACS
Nancy L. Gantt, MD, FACS
Lisa J. Gould, MD, PhD, FACS
Robert Samuel D. Higgins, MD, MSHA, FACS
Aliza Leiser MD, FACOG, FACS
Karthik Rajasekaran, MD, FACS
John H. Stewart IV, MD, MBA, FACS
Cynthia L. Talley, MD, FACS
Steven D. Wexner, MD, PhD(Hon), FACS, FRCS(Eng,Ed), Hon FRCS(I,Glasg,Eng)
Disclaimer
This information is published to educate you about preparing for your surgical procedures. It is not intended to take the place of a discussion with a qualified surgeon who is familiar with your situation. It is important to remember that each individual is different, and the reasons and outcomes of any operation depend upon the patient’s individual condition.
The American College of Surgeons is a scientific and educational organization that is dedicated to the ethical and competent practice of surgery; it was founded to raise the standards of surgical practice and to improve the quality of care for the surgical patient. The ACS has endeavored to present information for prospective surgical patients based on current scientific information; there is no warranty on the timeliness, accuracy, or usefulness of this content.
References
Hadland SE, Agarwal R, Raman SR, et al. Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings: Clinical Practice Guideline. Pediatrics. Published online September 30, 2024. doi:10.1542/peds.2024-068752
Kelley-Quon LI, Kirkpatrick MG, Ricca RL, et al. Guidelines for Opioid Prescribing in Children and Adolescents After Surgery: An Expert Panel Opinion [published correction appears in JAMA Surg. 2021 Apr 1;156(4):403. doi: 10.1001/jamasurg.2021.0003.]. JAMA Surg. 2021;156(1):76-90. doi:10.1001/jamasurg.2020.5045.
Sizar O, Genova R, Gupta M. Opioid-Induced Constipation. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493184/
Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23(3):293-7.
Regina AC, Goyal A, Mechanic OJ. Opioid Toxicity. [Updated 2025 Jan 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Accessed July 11, 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470415/
Ray JJ, Shackleford TL, Bronikowski D, Lubicky JP, Lancaster J, Grant DR. Pain Medication Disposal Rates After Pediatric Surgery. [Abstract] Hosp Pediatr. 2021;11(5):521-524. doi:10.1542/hpeds.2020-000398 .
Chua KP, Brummett CM, Conti RM, Bohnert A. Association of Opioid Prescribing Patterns With Prescription Opioid Overdose in Adolescents and Young Adults. JAMA Pediatr. 2020;174(2):141-148. doi:10.1001/jamapediatrics.2019.4878.
Harbaugh CM, Lee JS, Hu HM, et al. Persistent Opioid Use Among Pediatric Patients After Surgery. Pediatrics. 2018;141(1):e20172439. doi:10.1542/peds.2017-243
FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. U.S. Food and Drug Administration. August 31, 2016. Accessed June 10, 2025. https://www.fda.gov/media/99761/download.
Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 116(2):p 248-273, February 1, 2012. | DOI: 10.1097/ALN.0b013e31823c1030
Substance Abuse and Mental Health Services Administration. (2025). Key substance use and mental health indicators in the United States: Results from the 2024 National Survey on Drug Use and Health (HHS Publication No. PEP25-07-007, NSDUH Series H-60). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases.