Systemic analgesics in children

Safe and effective analgesia in children requires a multimodal analgesic approach, to optimize analgesic efficacy while minimizing side-effects. Ongoing monitoring and pain assessment, with age appropriate pain scoring systems are essential to guide treatment and allow optimization of pain control, while ensuring safety and minimizing unwanted effects.Pain in early life has been shown to lead to heightened sensitivity to pain on future exposure, due to neuroplasticity of immature pain pathways. Effective pain control in infants and children has therefore the added dimension of aiming to minimize development of longer-term neurodevelopmental changes, while achieving good analgesia at the time.An understanding of developmental changes in pharmacokinetics and pharmacodynamics of analgesic drugs in neonates, infants and children is key to safe and effective dosing of analgesic agents across this age range. Considerations for safe and effective use of paracetamol, non-steroidal anti-inflammatory drugs, opioids and adjuvant analgesics in children will be discussed.