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Pediatric patients receiving opioid prescriptions after orthopaedic surgery are an at-risk population amidst the ongoing opioid epidemic in the United States. While there is significant literature about opioid prescribing patterns and consumption among the adult population, there is limited data in the pediatric population. As a result of this limited knowledge, there remains substantial variation in practice patterns surrounding opioid use. This review evaluates the current literature regarding variation in opioid prescribing patterns in pediatric orthopaedic surgery patients with the aim of increasing awareness of risks and potential interventions.