Unsupported Browser
The American College of Surgeons website is not compatible with Internet Explorer 11, IE 11. For the best experience please update your browser.
Menu
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.

Become a Member
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.

Become a Member
ACS
For Patients

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.

pediatric-pain-1.jpg

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.

Providers: View a List of Available Resources

Common Questions

What is safe and effective pain management? 

Safe pain control means using medicines and non-medicine therapies that relieve pain while causing the fewest possible side effects. 

What are the goals of pain management?

  • Minimize pain
  • Keep your child moving
  • Speed healing
  • Help resume normal activities

Your surgical team will work with you and your child to:

  • Check for current opioid use and risk for overuse
  • Use alternatives to opioids whenever possible
  • Educate you about:
    • Different types of therapies and medications to treat pain
    • Using non-opioids or the lowest dose of opioids for the shortest amount of time
    • How to tell if your child is in mild, moderate, or severe pain
    • Safe temporary storage
    • How to get rid of any unused opioids when you are done with them
    • Knowing and recognizing the signs of opioid overdose and what to do

You can lower potential problematic substance use.

Only use opioids for severe pain. Safely get rid of any unused medication. Dispose of medications as soon as they are no longer needed. 

What are the most common pain management therapies and medications?

Some medications used during surgery may decrease your child’s need for opioids.

Therapy

Description

Self-care

Ice packs, raising the body part, and resting the surgical site

Distraction

Reading, games, music, videos, relaxation breathing 

Physical therapy

Guided exercises from a therapist

Light activity

Walking and normal play if surgeon allows it

Non-Medication Therapies - Mild Pain

Therapy

Description

Self-care

Ice packs, raising the body part, and resting the surgical site

Distraction

Reading, games, music, videos, relaxation breathing 

Physical therapy

Guided exercises from a therapist

Light activity

Walking and normal play if surgeon allows it

Medication
Considerations

Acetaminophen

Decreases pain and fever

Examples:

  • Children’s Tylenol®
  • Panadol®,
  • FeverAll® (suppository)
  • Generic brands available

Available as:

  • Flavored liquid
  • Tablets, capsules
  • Chewable tablets
  • Suppositories

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.

Non-Opioid, Oral Medication - Mild-to-Moderate Pain
Medication
Considerations

Acetaminophen

Decreases pain and fever

Examples:

  • Children’s Tylenol®
  • Panadol®,
  • FeverAll® (suppository)
  • Generic brands available

Available as:

  • Flavored liquid
  • Tablets, capsules
  • Chewable tablets
  • Suppositories

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.

See https://medlineplus.gov/ for more information.

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.

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. 

See https://medlineplus.gov/ for more information. 

Serious risks

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.

See: Recognizing and Responding to an Opioid Overdose


How can I help my child feel better?

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 to Do if You Think Someone is Overdosing | Stop Overdose | CDC

pediatric-pain-2.jpg

Do not share opioids. More than 40% of people who misuse opioids, including high school students, get them from a friend or relative.

Where should I keep medication during use?

  • In a secure location, preferably a locked cabinet or container.
  • Keep medication out of reach of children and pets.
  • Keep medication in its original container to avoid taking it by mistake.
  • Keep track of the location and number of pills or liquid in the bottle. 

Most opioids prescribed are not used. Get rid of any unused medicine when you are done.

How do I get rid of leftover opioids?

Dispose of opioids as soon as they are no longer needed.

  1. Check the medicine label. It may include how to dispose of the medicine.
  2. Ask your pharmacy for an FDA-approved mail-back bag or if they have a safe drop site.
  3. Check to see if your medication can be safely flushed down the drain.
  4. Mix unused pills with coffee grounds, dirt, or kitty litter in a plastic bag, and then throw it in the trash.
  5. View your options at the US Food and Drug Administration.

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).

Patient Tools

Additional Resources

Parents and Caregivers

Teens

Review Workgroup and Contributors

Original document reviewed August 2019 by:

Special thanks to our collaborators:

  • Kenneth Azarow, MD, FACS
  • David Powell, MD, FACS
  • Hale Wills, MD, FACS

Reviewed July 2025 by:

  • 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
Lenworth Jacobs, MD, MPH, DSc(Hon), FACS, FWACS(Hon)

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
  1. 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 
  2. 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.
  3. Acetaminophen: Medlineplus Drug Information. MedlinePlus. September 15, 2023. Accessed July 28, 2025. https://medlineplus.gov/druginfo/meds/a681004.html.
  4. Ibuprofen: Medlineplus Drug Information. MedlinePlus. September 15, 2023. Accessed July 28, 2025. https://medlineplus.gov/druginfo/meds/a682159.html.
  5. Hydrocodone combination products: Medlineplus Drug Information. MedlinePlus. June 15, 2025. Accessed July 28, 2025. https://medlineplus.gov/druginfo/meds/a601006.html.
  6. Hydromorphone: Medlineplus drug information. MedlinePlus. May 15, 2023. Accessed July 28, 2025. https://medlineplus.gov/druginfo/meds/a682013.html.
  7. Oxycodone: Medlineplus drug information. MedlinePlus. January 15, 2025. Accessed July 28, 2025. https://medlineplus.gov/druginfo/meds/a682132.html.
  8. Oxycodone combination products: Medlineplus Drug Information. MedlinePlus. May 15, 2025. Accessed July 28, 2025. https://medlineplus.gov/druginfo/meds/a625053.html.
  9. Morphine: Medlineplus drug information. MedlinePlus. March 15, 2024. Accessed July 28, 2025. https://medlineplus.gov/druginfo/meds/a682133.html.
  10. 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/  
  11. 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.
  12. 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/
  13. FDA Moves Forward with Mail-back Envelopes for Opioid Analgesics Dispensed in Outpatient Settings. U.S. Food and Drug Administration. April 3, 2023. Accessed August 13, 2025. https://www.fda.gov/news-events/press-announcements/fda-moves-forward-mail-back-envelopes-opioid-analgesics-dispensed-outpatient-settings.
  14. Miller EG, Hirsch L, eds. Giving opioid prescription pain medicine: What parents need to know (for parents) | nemours kidshealth. Nemours KidsHealth. October 2024. Accessed June 4, 2025. https://kidshealth.org/en/parents/opioid-prescription-safety.html?WT.ac=ctg.
  15. 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 .
  16. 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.
  17. 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 
  18. Screening tools for adolescent substance use. National Institutes of Health. May 30, 2019. Accessed June 4, 2025. https://nida.nih.gov/nidamed-medical-health-professionals/screening-tools-resources/screening-tools-adolescent-substance-use.
  19. U.S. Surgeon General’s advisory on Naloxone and opioid overdose. US Department of Health and Human Services. April 8, 2022. Accessed June 4, 2025. https://www.hhs.gov/surgeongeneral/reports-and-publications/addiction-and-substance-misuse/advisory-on-naloxone/index.html.
  20. 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.
  21. 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
  22. 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.
  23. Drug disposal: Drug take-back options. U.S. Food and Drug Administration. October 31, 2024. Accessed July 2, 2025. https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-drug-take-back-options.
  24. Drug disposal: FDA’s flush list for certain medicines. U.S. Food and Drug Administration. October 31, 2024. Accessed July 2, 2025. https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-fdas-flush-list-certain-medicines.
  25. Drug disposal: Dispose “non-flush list” medicine in Trash. U.S. Food and Drug Administration. October 31, 2024. Accessed July 2, 2025. https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-dispose-non-flush-list-medicine-trash.
  26. Disposal of unused medicines: What you should know. October 31, 2024. Accessed July 2, 2025. https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know.
  27. Patients’ frequently asked questions about prescription opioids. Centers for Disease Control and Prevention. November 1, 2024. Accessed July 11, 2025. https://www.cdc.gov/overdose-prevention/manage-treat-pain/patients-faqs.html.
  28. Understanding drug use and addiction drug facts. National Institutes of Health. June 2018. Accessed July 11, 2025. https://nida.nih.gov/publications/drugfacts/understanding-drug-use-addiction.
  29. Misuse of prescription, opioids, and fake pills. SAMHSA. June 6, 2023. Accessed July 11, 2025. https://www.samhsa.gov/substance-use/learn/prescriptions-opioids.
  30. Prescription Opioids DrugFacts. National Institutes of Health. June 2021. Accessed July 11, 2025. https://nida.nih.gov/publications/drugfacts/prescription-opioids.
  31. What to Do if You Think Someone is Overdosing. Centers for Disease Control and Prevention. April 2, 2024. Accessed July 23, 2025. https://www.cdc.gov/stop-overdose/response/index.html

This content is produced in collaboration with the following organizations:

  • American Pediatric Surgical Association
  • American Society of Health-System Pharmacists (ASHP®)