ToolsCalculators
Withdrawal Assessment Tool (WAT-1) for pediatric withdrawal
Scores iatrogenic opioid/benzodiazepine withdrawal in children.
Withdrawal Assessment Tool (WAT-1) for pediatric withdrawal
Loose or watery stools (previous 12 h)
Vomiting, retching or spontaneous gagging (previous 12 h)
Temperature > 37.8 °C (previous 12 h)
Behavioural state (pre-stimulus, 2-min observation)
Tremor
Any sweating
Uncoordinated or repetitive movement
Yawning or sneezing
Startle to touch (during stimulus)
Muscle tone (during stimulus)
Time to regain calm state after stimulus
Result0 points
Score below 3; withdrawal unlikely at this assessment.
- Withdrawal threshold (>= 3)
- Not met
When to use
- Serial assessment of opioid and benzodiazepine withdrawal in children weaning after prolonged sedation in the PICU.
Formula
Sum of 11 items (range 0-12): loose stools, vomiting/retching, temperature > 37.8 C, behavioural state, tremor, sweating, uncoordinated/repetitive movement, yawning/sneezing, startle to touch, muscle tone, and time to regain a calm state. Score >= 3 indicates withdrawal.
Pearls and pitfalls
- The first three items are drawn from the prior 12-hour nursing record; the remainder are scored during a progressive stimulus (pre-stimulus observation, touch, then recovery).
- SBS refers to the State Behavioral Scale used to anchor the behavioural-state item.