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Is Codeine Still The Best Choice For Pediatric Pain Management?

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The physician’s group is advising healthcare providers to stop prescribing codeine-based medication to children, and is looking to increase awareness of the risks of the drug in those under the age of 18.

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September 21, 2016 | by Sarah Hand, M.Sc.

According to the American Academy of Pediatrics (AAP), the answer to this question is a resounding “no.” The physician’s group is advising healthcare providers to stop prescribing codeine-based medication to children, and is looking to increase awareness of the risks of the drug in those under the age of 18.

The AAP’s most recent clinical report on the issue was published in the journal, Pediatrics. According to the article, the common painkiller has been linked to serious breathing-related reactions but is nevertheless still prescribed to children quite regularly.

Codeine is an opioid that has been used in both prescription and over-the-counter medications for decades. The drug is broken down into morphine in the liver but due to the variable metabolic rates among individuals, a standard dose may have a strong effect on some, and an inadequate effect on others.

Children are especially vulnerable to the effects of rapid metabolism, which could cause a standard dose of codeine to severely slow breathing rates, potentially leading to death. Those with additional compounding health factors, including obstructive sleep apnea, face an even higher risk of codeine-associated complications.

In addition to the AAP, the World Health Organization (WHO) and the US Food and Drug Administration (FDA) have also documented the risks of codeine use in pediatric patients. Despite the available data, over-the-counter cough syrups are still sold without a prescription in the District of Columbia along with 28 US states.



Codeine also remains a commonly prescribed painkiller for children following routine surgeries, including tonsillectomies. Between 2007 and 2011, over 800,000 patients aged 11 and under were prescribed codeine, according to a study presented in the AAP’s report. Ear, nose and throat specialists – known as otolaryngologists – prescribed codeine most frequently at 19.6 percent, while dentists, pediatricians and family physicians accounted for 13.3, 12.7, and 10.1 percent of all prescriptions, respectively.

The AAP report points out a few alternatives to codeine for pain relief in children, however the authors admit that there is a lack of safe painkillers available to pediatric patients. “Effective pain management for children remains challenging because children's bodies process drugs differently than adults do,” said Dr. Joseph D. Tobias, the report’s lead author.


Keywords: Opioid, Pediatrics, Pain Management


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