Weaning Children Off Prescription Pain Medicine After Surgery

These guidelines are intended to help you wean your child off pain medicine prescribed for use after surgery. If you have received specific instructions on weaning from your provider, please follow those instructions.  

Remember: Each child is unique and different people respond to pain in different ways.  The length of time a child needs pain medicine, depends on the type of surgery performed and the child’s medical history.

This guide refers ONLY to pain medicine that requires a prescription from a physician.  If your child is prescribed over-the-counter medicine, such as acetaminophen (Tylenol), do NOT adjust its dose. However, take into account that other common medicines, such as cold medicines, sometimes contain acetaminophen as an ingredient. Remember not to exceed the maximum daily dose of acetaminophen from ALL sources.  You may increase the amount of time between doses until your child is comfortable without any pain medicine. 

Pain should not increase over time. If it does, call Telehealth Nursing at 651-229-3890. 

Weaning is slowly decreasing the amount of medicine used, working toward the goal of stopping use of the medicine entirely.

• Typically, you can start weaning off medicine one or two days after coming home from the hospital. 
• You might choose to start weaning sooner if your child is too sleepy. 
• Typically, opioids (oxycodone) and muscle relaxants (diazepam/Valium, hydroxyzine/Vistaril)   are no longer needed one week after surgery. Acetaminophen (Tylenol) or ibuprofen may be needed for one to two weeks after surgery. Some caregivers find that they can stop using the medicines sooner—sometimes within a few days of arriving home. 

General Tips

• First day at home: Continue the pain medicine schedule established in the hospital. 
• Pain medicines can take up to 30 minutes to begin working. Don’t wait until your child is in a lot of pain before you give it.
• After the first night at home: Try not to wake your child overnight to give pain medicine. When children wake up on their own during the night, it’s OK to give them medicine.
• Give pain medicine just before bed and right away in the morning. 
• Providing comfort using other methods, including warm packs, ice packs, massage, and slow deep breathing. 
• It is common to have increased pain at nighttime. Use the additional pain relief methods mentioned above and plan your dosing so that you can give a dose before bedtime. 
• Distraction can also be very helpful when a child is in pain. Engage your child in activities to help keep his or her mind busy. Playing music or other noise while your child is in bed might help provide distraction at night. 

You have two options for weaning your child off pain medicines:

1. Increase the amount of time between doses.
2. Decrease the amount of medicine you give.

Option 1: Increase the amount of time between doses.

• Start by increasing the amount of time between doses by one hour.  For example, if your child has been getting pain medicine every four hours, try going five hours between doses for three or four doses. Then, if your child is still comfortable, try going six hours between the next few doses.   
• If your child is feeling too much pain, go back to the time between doses that was keeping them comfortable. A day later, try again to continue the weaning process. 
• If increasing time between doses is going well, continue increasing the time until they are given every 12 hours.  Then, you can give the medication as needed. 

Option 2:  Decrease the amount of medicine you give over time.

• Start by giving half of the original dose. (This might require you to cut pills in half.) Continue this decreased dose for one day before decreasing the dose again. 
• If you’ve given a smaller dose of medicine two or three times and your child is still comfortable, start increasing the amount of time between doses, or stop giving the medicine. If your child is feeling too much pain, return to the dose that was keeping them comfortable.  A day later, try again. 

Regardless of which option you use, weaning a child off pain medicine is a repeating cycle of trying something to see if it works to keep your child comfortable.  If you’ve been unable to wean your child off pain medicine and are still using the medicine one week after surgery, call Telehealth Nursing at 651-229-3890 for further evaluation and guidance.