Opioids In Children

Introduction According to the American Medical Association, infants and children may experience a heightened pain stimulus as a result of stronger inflammatory response and lack of central inhibitory influence. Data collected from the Netherlands, United Kingdom, and Italy show that analgesics are one of the most commonly prescribed drug classes in children and adolescents (Fredheim, 2010). Analgesics are also known as painkillers, and include the group of opioids. Opioids are defined as any morphine-like synthetic narcotic that produces the same effects as drugs derived from the opium poppy. They bind to the opiate receptors on the surface of cells. Opioids reduce the intensity of pain signals reaching the brain and affect the areas of

They are used after surgery, to treat cancer pain, and for children who experience ongoing pain. Symptoms of opioids include nausea, vomiting, sedation, pruritus, respiratory depression, and constipation (West Midlands Pedatric Macmillion Team 2005). Constipation is the most common adverse reaction. It affects quality of life and causes additional stress in children already suffering from serious illnesses. Although children over time get used to the other effects of opioids, such as drowsiness, they never adapt to constipation. This condition causes pain with defecation. Along with painful bowel movements, children who are constipated may also experience stomach pain, moodiness, and a lack of appetite (Greenwald, 2010). Opioid drugs interact with opioid receptors located in the brain and spinal cord that control the defecation reflex, which causes constipation. Opioid drugs slow the peristaltic process, however, they increase absorption of water and electrolytes from the gut, which causes feces to become dry and hard. Constipation not only causes hard stools and incomplete evacuation, but also bloating, pain, increased reflux, nausea, and vomiting. Bell (2009) administered a survey to 322 patients on opioid therapy, measuring the prevalence, severity, and impact of opioid-induced bowel dysfunction. He found that 81% of the patients experienced constipation, and 58% of the

There are few studies done that examine the long-term neuropsychological effects. De Graaf (2011) conducted a five-year follow up of a randomized controlled trial looking at differences in cognitive functioning in children who received morphine during the neonatal period. The study analyzed children, 5 years of age, who had received morphine as newborns on ventilatory support. These children were tested on intelligence, visual motor integration, behavior, chronic pain, and health-related quality of life. The results showed significantly lower IQ and visual motor integration scores for children who received morphine during the neonatal period (De Graaf, 2011). In a similar study, Ferguson (2012) researched the effects of head circumference, social behavior, and response latencies in young children who received morphine during the neonatal period. She found that children who received morphine had smaller head circumferences by 7% and lower body weights by 4%. Ferguson also tested short-term memory task by using a delayed matching to sample test and found that children who received morphine experienced significantly longer choice response latencies than the placebo group. The children also finished 27% less of the task than the placebo group. The results of this study also suggest long-term social behavioral consequences. Parents of children who were