Hydromorphone in Pediatric Pain Management: Pharmacology, Clinical Applications, and Safety Considerations—A Narrative Review

Background: Pain is one of the most common and challenging clinical problems in pediatric care, affecting up to three-quarters of hospitalized children. Hydromorphone has gained increasing clinical interest as an alternative opioid in pediatric settings, although evidence supporting its use remains limited. Methods: A narrative literature review was conducted in accordance with SANRA recommendations using PubMed, Embase, and the Cochrane Library to identify studies evaluating hydromorphone use in pediatric and adolescent patients across perioperative, postoperative, intensive care unit (ICU), and emergency settings. Results: Available evidence suggests that hydromorphone may provide effective analgesia in pediatric patients across multiple clinical contexts, including postoperative pain control, patient-controlled analgesia, analgosedation in the ICU, and acute pain management in the emergency department. However, the available data are largely derived from small, heterogeneous, and predominantly retrospective studies, often limited to single-center experiences. Conclusions: Hydromorphone may represent a useful alternative opioid for pediatric pain management and analgosedation, particularly when morphine is ineffective or poorly tolerated. Nevertheless, the current evidence base is limited, heterogeneous, and largely observational, precluding robust conclusions regarding its comparative effectiveness and safety. Further well-designed pediatric studies are required to better define its role in clinical practice.