Withdrawal Assessment Tool (WAT-1) for Pediatric Withdrawal

The original study authors recommend scoring from the first day of weaning in patients who have received opioids and/or benzodiazepines for ≥5 days (by infusion or periodic dosing), and to continue twice daily scoring until 72 hours after the last dose.

They also recommend completing along with the State Behavioral Scale (SBS) (see Evidence for details) at least once per 12 hour shift (e.g. at 8:00 and 20:00 ±2 hours). The progressive stimulus used in the SBS assessment provides a standard stimulus for observing signs of withdrawal.

Scores ≥3 suggest severe withdrawal symptoms. Children on continuous sedation for ≥5 days are more likely to have WAT-1 scores ≥3.

Up-trending scores suggest worsening withdrawal and may require addition of withdrawal-preventive medications (e.g. methadone or lorazepam), additional one-time doses, or adjustments in dose or dosing schedule.

Consider addition of withdrawal-preventing medications in children on IV sedation for ≥5 days.

Frequently reassess children who are weaning off sedation medications for respiratory depression and oversedation. Oversedation can occur even in patients who have had severe withdrawal symptoms, and may require rescue medications like naloxone.