So I've got this kid. Mom's been in a methadone program for two years now. He's ten days old, had been weaning with phenobarb, but yesterday they started 0.5mg/kg of morphine because his Finnegans were consistently around 15. Overnight he was getting 7s. I come in, never had the kid before, and I'm adding up to 14, 12, etc. So we increase the morphine from q6h to q4h. Hand to god, the kid gets WORSE. Won't eat (while the previous two feedings he took 35ml), writhing around, red puffy eyes, just miserable. The lowest score I got, half an hour after his last dose, was 6. He's dead asleep, but he's jittery (yes, asleep), tachypneic, congested, flaring, and I know he's got that diaper rash. So the resident, bless her heart, starts giving me static about how she's going to have to write for more morphine if I keep scoring him like this, etc, while she was actually at my bedside one time when I scored him and certainly didn't disagree with anything I found. I, uh, may have asked her if she was asking me to falsely document a low score, but in my defense it was shift change.
So my question, other than how best to hide said resident's body, is what are we missing? Baby gets almost no visitors; mom and dad come in for around five minutes per day and don't touch him, so I spent as much time holding him as I could, but clearly that's not enough. Do any of you use something OTHER than morphine to wean kids off mom's methadone? Clearly just increasing his frequency isn't working.
