• Ernest A Kopecky.
• Clin J Pain. 2019 Jun 1; 35 (6): 481-486.

Aims/Objectives/BackgroundChildren represent a patient demographic composed of multiple, unique subpopulations differentiated by rapidly changing age-related physiology, which includes the means of metabolizing opioids. Opioids are an important part of the pharmacological treatment of both acute and chronic pain. In both clinical medicine and clinical research, it is necessary to understand the differences in drug handling by age cohort in order to appropriately dose children to effect, and to avoid exacerbating deleterious adverse events with potentially grave sequelae.MethodsTopical review using data from a targeted PubMed literature search.ResultsProtein binding, tissue solubility, weight, size (body mass, surface area), blood flow, drug metabolism, and renal function are key determinants of dosing across the different pediatric age cohorts. Each variable functions to elicit a change in drug exposure and therefore varying clinical effect.ConclusionsUnderstanding how these variables change the pharmacokinetics and pharmacodynamics of each opioid is critical to the successful and safe management of pain in children.

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