Oral drugs for mild, acute nociceptive pain in children

Paracetamol should be used first line for mild, acute nociceptive pain because of its favourable safety profile. NSAIDs should not be used in infants younger than 3 months.

For infants aged 1 to 3 months with mild, acute nociceptive pain, if paracetamol is deemed necessary based on medical assessment, use:

paracetamol immediate-release 15 mg/kg up to 90 mg orally, 6-hourly if required. Maximum 60 mg/kg up to 360 mg in 24 hours. acute pain, mild (children) paracetamol

For children older than 3 months with mild, acute nociceptive pain, use:

paracetamol immediate-release 15 mg/kg (for overweight children, use ideal body weight) up to 1 g orally, 4-to 6-hourly if required. Maximum 60 mg/kg up to 4 g in 24 hours. paracetamol

The combination of paracetamol and an NSAID is synergistic, and improved pain relief is achieved compared with either drug alone. If paracetamol alone is unlikely to provide adequate analgesia, paracetamol and NSAIDs may be used together; however, NSAIDs can cause significant adverse effects and their use is contraindicated in some patients. In children, the combination of paracetamol and an NSAID increases the risk of acute kidney injury and hydration should be optimised. For children older than 3 months with mild, acute nociceptive pain, use:

paracetamol immediate-release 15 mg/kg (for overweight children, use ideal body weight) up to 1 g orally, 4-to 6-hourly if required. Maximum 60 mg/kg up to 4 g in 24 hours paracetamol

PLUS

ibuprofen 5 to 10 mg/kg (for overweight children, use ideal body weight) up to 400 mg orally, 8-hourly if required. Maximum 30 mg/kg up to 1.2 g in 24 hours. acute pain, mild (children) ibuprofen

An NSAID may be considered as monotherapy for mild, acute nociceptive pain with an inflammatory component. For children older than 3 months with mild, acute nociceptive pain, use:

ibuprofen 5 to 10 mg/kg (for overweight children, use ideal body weight) up to 400 mg orally, 8-hourly if required. Maximum 30 mg/kg up to 1.2 g in 24 hours. ibuprofen

If oral administration is not possible (eg the patient cannot take oral medications, or has impaired gastrointestinal absorption), consider an alternative route of administration.