View All Articles

Why codeine isn’t a good medicine for your child

April 25, 2014

We never really plan a trip to the emergency room. We don’t anticipate our children falling off their bicycles and breaking their arms or our babies waking up screaming in pain in the middle of the night. But, it happens sometimes. And when it happens to you (like it does to every parent at some point or another), here’s something important you should know.

Medicines containing codeine aren’t the best option for your child.

Codeine is an opioid medication that has been used in children and adults to relieve mild to moderate pain and also to help relieve coughing. You may have seen it in the form of Tylenol with codeine, Tylenol #3, Robitussin AC, Guiatuss AC and many other combinations. For a more complete list of brand-name products, check here.

While codeine has been used safely and effectively in adults, the American Academy of Pediatrics has advised against the use of medications containing codeine in children. However, a recent study reviewed emergency room visits for children over the years 2001 to 2010 and found that children are frequently prescribed medications containing codeine.

Codeine isn’t effective at relieving cough

One of the most important things to know about taking care of children is that they aren’t simply small adults. A kid’s body works differently than a grown-up’s. While codeine is effective at relieving cough in adults, there is no evidence that it’s effective in kids. In fact, there are some studies that show that codeine is no more effective than placebo at relieving cough in children.

Codeine doesn’t relieve pain for everyone

Codeine is a medication that isn’t active in the body until the liver chemically transforms the drug into its active form. Because of genetic variations, nearly one-third of children aren’t able to convert the medication into the active form that will relieve their pain. This means that codeine simply does not work for roughly a third of children, and they are left in pain.

Codeine can be very unsafe

On the flip side, some children’s bodies rapidly convert codeine into its active form, which gives them exponentially higher doses of the drug than intended. While these genetic variations also exist in adults, children are more susceptible to the potential problems that can occur.

This means that a child can be given the correct dose of medication, yet still suffer the effects of an overdose, and there is no way to tell in advance who is likely to experience this effect. Children can have trouble breathing, become extremely sleepy or sedated, experience rash, vomiting, swelling. In extreme cases, some children have required mechanical ventilation or died after their breathing was diminished due to side effects from codeine.

Because of the unpredictable effects of codeine and its potentially fatal outcomes, experts have advised against the use of codeine in children.

What should you do?

If your child suffers an injury and requires a trip to the doctor’s office or emergency room, pay attention if your doctor prescribes medication for pain. Ask what’s in the medication, what side effects can occur, and what warning signs to look for.

Ibuprofen has been shown to be safe and effective at relieving injury pain in children. Acetaminophen is also an option. Hydrocodone is another medication that, although it is an opioid like codeine, has been shown to be a safe alternative for kids.

If your child has an upper respiratory infection and is given a cough medicine, read the label carefully to determine whether it contains codeine. If you’re not sure, ask your pharmacist before they fill the medication at the pharmacy. If the cough medicine does contain codeine, you can ask the pharmacist to contact your doctor for an alternative due to your concerns about giving your child codeine.

Most upper respiratory infections, while troublesome, will resolve on their own within a few days and don’t require medicine for treatment. The best remedy is to give your child plenty of fluids and provide a humidifier to moisten the air.

If your child has more complicated, chronic issues than those covered here, talk to your doctor. Weigh the pros can cons that are specific to your child’s needs. Work together to find the best and safest way to care for your child.