Morphine for pain relief in children

Pain relief is important

Poorly managed pain can lead to a longer recovery. This is why medications are used to treat pain, especially for procedures or illnesses that are known to cause pain. Some types of pain cannot be prevented completely—the aim is to treat pain effectively.

If a child is expected to have severe pain, pain that lasts over time, or constant pain, pain-relieving medicines should be used early. This way, pain is relieved before it gets too severe. For example, if a child is going to have surgery, pain relief is given right away because the recovery after the surgery will be painful.

Morphine works very well to manage many types of severe pain, so it is often used in cases like these.

Opioids are indicated for moderate to severe pain. They are used for short-term pain management in the lowest, safest and most effective dose. The goal is to avoid unwanted side effects and prevent harm.

Common concerns about giving morphine to children

Safety

Morphine and other opioids are carefully prescribed and closely monitored to ensure they are safe to give to children, even newborns. Health-care providers follow very strict guidelines to make sure that the right amount of any drug is given. The size, age and condition of a child are always taken into account when deciding the amount of morphine a child needs. These measures mean the chance of giving too much of a drug (overdose) is low.

Addiction

Some parents worry their child will become addicted to morphine. Addiction is a psychological dependence. In other words, it is a craving in the brain. While it is true that opioids can be addictive, opioids can be used safely and effectively in children. When they are prescribed for a short time and for the purpose of treating acute severe pain, the risk of addiction is extremely low. Talk to your child’s health-care team about any concerns you may have about your child receiving opioids.

How opioids are given

Morphine and other opioids can be given to children in many forms. If children are able to eat, drink and swallow, oral (by mouth) medication is generally preferred. This can be liquid or tablets. Intravenous (IV) morphine can be used when an oral route is not available. These are the most common ways to give opioids, but other routes also exist.

Side effects of morphine

Most side effects from morphine are not serious. Many can be prevented before a problem starts. Mild side effects include:

• Difficulty having bowel movements (constipation): Laxatives or stool softeners can prevent this.
• Nausea and vomiting: Medicines can be given to avoid these.
• Itchiness: Medicines are available to reduce itchiness.
• Children may also feel drowsy, feel like they want to pee (urinary retention), and their moods may change.

Rarely, morphine can have more serious side effects. However, these can also be managed safely.

Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's health-care provider right away or take your child to the closest Emergency Department if your child has any of these side effects:

• dizziness
• fainting
• feeling extra sleepy
• having a hard time breathing
• slow and shallow breathing rate

Dependence and withdrawal

A child can develop dependence when they take morphine. Dependence means that the child's body has become used to having the medicine. When the medicine is no longer in the body, withdrawal can occur. Symptoms of withdrawal include:

• nausea
• diarrhea
• fever
• shivering
• sweating
• stomach pain

To avoid symptoms of withdrawal, your child will slowly be given less morphine until they no longer take the medicine.

Dependence is not the same thing as addiction, which is a psychological craving for a drug.

Other pain-relieving medicines

Morphine may be prescribed on its own or with other pain relievers such as acetaminophen and non-steroidal anti-inflammatory medicine (NSAIDs). NSAIDs include naproxen, ibuprofen, celecoxib and meloxicam.

Other opioid medications

Other opioid medications may be prescribed to manage acute severe pain, including hydromorphone and oxycodone. Codeine is not recommended for children.

For more information, talk to your child's nurse about pain medicines and other ways to relieve a child's pain.

Keep morphine out of your child’s sight and reach and locked up in a safe place. If your child takes too much morphine, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.