These guidelines are intended to help you wean your child off pain medicine prescribed for use after extensive orthopedic surgery.

This guide refers ONLY to pain medicine that requires a prescription from a physician.  If your child is prescribed over-the-counter medicine, such as acetaminophen (Tylenol), do NOT adjust its dose. However, take into account that other common medicines, such as cold medicines, sometimes contain acetaminophen as an ingredient. Remember not to exceed the maximum daily dose of acetaminophen from ALL sources.  You may increase the amount of time between doses until your child is comfortable without any pain medicine. 

Remember: Each child is unique. And different people respond to pain in different ways.  The length of time a child needs pain medicine varies, depending on the type of surgery performed and the child’s medical history. 

Pain should not increase over time. If it does, call Telehealth Nursing at 651-229-3890. 

Weaning is slowly decreasing the amount of medicine used, working toward the goal of stopping use of the medicine entirely.

• You can start the weaning process when your child is comfortable and can participate in activities. Typically, that’s one or two days after coming home from the hospital.
• You might choose to start weaning sooner if your child is too sleepy.
• Typically, pain medicine is no longer needed two to three weeks after surgery. Some families find they can stop using the medicines sooner—sometimes within a few days of arriving home.

General Tips

• First day at home: Continue the pain medicine schedule established in the hospital.
• After the first night at home: Try not to wake your child overnight to give pain medicine. When children wake up on their own during the night, it’s OK to give the medicine.
• Give pain medicine just before bed and right away in the morning. 
• Give pain medicine before events or activities (such as physical therapy) that might be painful.
• While weaning your child off pain medicine, try also providing comfort using other methods, including warm packs, ice packs, massage, slow deep breathing, and elevating the affected arm or leg.
• Distraction can also be very helpful when a child is in pain. Engage your child in activities to help keep his or her mind busy. Playing music or other noise while your child is in bed might help provide distraction at night.
• If your child has been prescribed medicine for muscle spasms or muscle tightness—and spasms are causing pain—continue to give that medicine. You may use this handout’s guidelines for weaning your child off pain medicines to also help wean your child off spasm medicines.

You have two options for weaning your child off pain medicines:

1. Increase the amount of time between doses.
2. Decrease the amount of medicine you give, over time.

Option 1: Increase the amount of time between doses.

• Start by increasing the amount of time between doses by one hour.  For example, if your child has been getting pain medicine every four hours, try going five hours between doses for three or four doses. Then, if your child is still comfortable, try going six hours between the next few doses.  
• Typically, effects of pain medicine do not last longer than six hours. So if your child is still comfortable six hours after taking the medicine, start decreasing the amount of medicine you give for each dose, or stop giving the medicine—unless your child starts to complain of pain.
• If your child is feeling too much pain, go back to the dose that was last keeping him or her comfortable. A day later, try again to continue the weaning process.
• Pain medicines can take up to 30 minutes to begin working. So don’t wait until your child is hurting a lot before you give it.

Option 2:  Decrease the amount of medicine you give, over time.

• Start by giving half the original, full dose. (This might require you to cut pills in half.) Continue this decreased dose for one day before decreasing the dose again.
• If you’ve decreased the pain medicine dose two or three times and your child is still comfortable, start increasing the amount of time between doses, or stop giving the medicine—unless your child starts to complain of pain.
• When you’re in the process of decreasing the doses of pain medicine you give, you might still need to give a higher dose at night if your child is having more pain at night or is having trouble sleeping.
• If your child is feeling too much pain, go back to the time interval between doses that was last keeping him or her comfortable.  A day later, try again to continue the weaning process.

Regardless of which option you use, weaning a child off pain medicine is a repeating cycle of trying something and testing to see if it works to keep the child comfortable.  If you’ve been unable to wean your child off pain medicine and are still using the medicine three weeks after surgery, call Telehealth Nursing at 651-229-3890 for further evaluation and guidance.