The People's Perspective on Medicine

Why Is Codeine the Wrong Pain Reliever for Kids?

Some youngsters cannot metabolize codeine fully and it becomes deadly. Doctors should rely on acetaminophen or ibuprofen first.
Illness asian child admitted at modern and comfortable equipped hospital room. Health care and people concept. Vignette and vintage style.

Doctors used to prescribe codeine to kids who’d undergone a tonsillectomy or appendectomy. They believed that this narcotic was less potent and hence not as risky as more powerful opioids.

However, the FDA has determined that this opioid is not safe for children. It can even be deadly. The agency has warned doctors not to prescribe this drug to children for any reason. It requires a black box on the prescribing label to this effect.

Have Doctors Stopped Prescribing Codeine?

After this caution was issued, most doctors did stop prescribing this pain reliever. But a review of the records of more than 300,000 children between 2010 and 2015 showed that surgeons were still prescribing codeine for about 5 percent of children after a tonsillectomy and adenoidectomy  (Chua, Shrime & Conti, Pediatrics, Nov, 2017).

According to the FDA, doctors should prescribe ibuprofen or acetaminophen for children following this type of surgery. If pain is unexpectedly severe and a child really needs an opioid analgesic, they might offer hydrocodone or oxycodone instead.

Some youngsters could not metabolize codeine readily. As a result, the drug built up to dangerously high levels in their bloodstreams. Oxycodone and hydrocodone are not metabolized through the same pathway, so they don’t pose the same risk.

Of course, such opioids carry their own hazards. Doctors should choose non-narcotic pain relievers for youngsters whenever possible.

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    About the Author
    Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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