ABSTRACT
Oral morphine is normally given q4h for an instant-release preparation, but infants and children may need it every 2–3 hours. Morphine can be given once or twice daily depending on which controlled-release preparation is used. Patients on non-opioids should not be started on potent strong opioids such as transdermal fentanyl. Patients already on higher doses of a regular weak opioid can start a strong opioid equivalent to their dose. Opioids should not be increased by more than 50%. For children some use smaller routine increases of 25%. Increases are usually every third day, but faster titration (twice daily) can be done under supervision. Faster titration is useful if urgency is an issue, but it also increases the likelihood of adverse effects. There are important differences in using opioids in children with respect to starting doses, dosing frequency, adverse effects and useful routes.
