Analgesic

Route

Dose

Maximum dosing

Notes

Mild to moderate pain

Sucrose

oral 

0.1–0.5 mL increments

<3 months:
5 mL/day

≥3 months:
10 mL/day

Children 0–18 months (most effective in younger children)
Provide dose 2 minutes prior to painful procedure (with dummy if available)

and / or

Paracetamol

oral

15 mg/kg (max 1 g)
4–6 hourly

Birth - 1 month:
60 mg/kg/day

>1 month:
90 mg/kg/day (up to 4 g/day)

Dose on ideal body weight
Dose commercial syrup carefully as available in several strengths

PR

15–20 mg/kg (max 1 g)
6 hourly

Birth - 1 month:

60 mg/kg/day

> 1 month:
90 mg/kg/day (up to 4 g/day)

If oral not tolerated
Dose on ideal body weight
125 mg, 250 mg, 500 mg suppositories available
PR medication should be avoided in immunocompromised children

IV

<1 month
10 mg/kg 6 hourly
>1 month
15 mg/kg 6 hourly (max 1 g)

< 1 month:

40 mg/kg/day

> 1 month:

60 mg/kg/day (up to 4 g/day)

If oral/PR not tolerated
Dose on ideal body weight
Dose (mg) and volume (mL) errors have caused significant overdoses in young children

and / or

Ibuprofen

oral 

>3 months:
10 mg/kg
(max 400 mg)
6–8 hourly with food

30 mg/kg (up to 2.4 g/day)

Precautions include renal impairment, dehydration, bleeding and anticoagulant use
Asthma is not a contraindication
Dose commercial syrup carefully as available in several strengths

Moderate to severe pain

Use medications above, and consider adding the following

Oxycodone  

oral

1–12 months: 0.05–0.1 mg/kg, 
>12 months:
0.1–0.2 mg/kg
4 hourly 

5–10 mg
4 hourly

For short term use
Do not prescribe for outpatient use if no clear diagnosis
Higher / more frequent dosing can be used in inpatient settings

or

Morphine

IV / subcutaneous

0.05 mg/kg
>12 months: up to 0.2 mg/kg (max 5–10 mg)

Cumulative maximum
<1 month: 

0.1 mg/kg 4–6 hourly
1–12 months:

0.1 mg/kg 2–4 hourly
>12 months:

0.2 mg/kg 2–4 hourly

Higher / more frequent dosing can be used in inpatient settings

or

Fentanyl

Intranasal

>12 months:
0.75–1.5 microg/kg
(max 75 microg)
10 minutely

Total dose of 3 microg/kg

Rapid onset (5 minutes)
Divide dose between nostrils
Consider alternative ongoing analgesia after second dose
Not recommended <12 months of age

or

Tramadol

oral / IV

1–18 years
0.5–1 mg/kg (max 100 mg)
6–8 hourly

8 mg/kg (up to 400 mg/day)

Can give up to 2 mg/kg if no risk sleep apnoea/risk factors for respiratory depression
Avoid in epilepsy (lowers seizure threshold) and patients on SSRIs (risk of serotonin syndrome)