Withdrawal Assessment Tool (WAT-1) for Paediatric Iatrogenic Withdrawal
Validated 11-item tool for assessing iatrogenic opioid and benzodiazepine withdrawal in critically ill children. Assesses symptoms over the past 12 hours plus a 2-minute observation period.
Score interpretation
WAT-1 < 3 -- no significant iatrogenic withdrawal detected
→ Continue the current weaning plan per the unit protocol. Score WAT-1 at least twice daily (every 12 h) from the first wean until 72 h after the last dose. Non-pharmacological comfort: swaddling, positioning, skin-to-skin, minimal stimulation, cluster care.
WAT-1 >= 3 -- significant iatrogenic withdrawal; treatment modification required
→ Pause or slow the opioid / benzodiazepine wean; give a rescue dose and consider increasing the daily dose before restarting a slower wean, per the unit weaning protocol. Consider adjuncts (e.g. clonidine) or conversion to enteral methadone after prolonged infusions — take doses from a children's formulary and with the PICU pharmacist. Minimise stimulation (low light, noise reduction, cluster care); support the family; document scores.
Interpretation bands for the WAT-1. Apply clinical judgement and local guidance.
References
- Franck LS et al. The Withdrawal Assessment Tool-1 (WAT-1): an assessment instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients. Pediatr Crit Care Med. 2008;9(6):573-580.
- Best KM et al. A systematic review and meta-analysis of iatrogenic withdrawal symptoms in paediatric intensive care units. BMJ Paediatrics Open. 2019;3(1):e000364.
Related
Curated clinical cross-links plus same-class fallbacks.
- Oxygenation Index (OI) · Critical Care
- Paediatric Early Warning Score (PEWS) · Critical Care
- Paediatric Fluid Resuscitation Calculator · Critical Care
- Paediatric Index of Mortality 3 (PIM3) · Critical Care
- Berlin Criteria for ARDS · Critical Care
- Berlin Criteria for Acute Respiratory Distress Syndrome (ARDS) · Critical Care
- Morphine (Paediatric) · Opioid Analgesic — Moderate to Severe Pain in Children
- Midazolam (Paediatric) · Benzodiazepine — Status Epilepticus (First-Line) / Procedural Sedation
- Remimazolam · Ultra-Short Acting Benzodiazepine (Procedural Sedation)
- Ibuprofen (Paediatric) · NSAID / Analgesic / Antipyretic
- Paracetamol (Paediatric) · Analgesic / Antipyretic — First-Line Pain and Fever in Children
- Diazepam (Paediatric) · Benzodiazepine — Status Epilepticus / Febrile Convulsions (Community)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.