Codeine not safe for kids, paediatricians warn

paediatric deaths related to codeine in 2013, including a 10-year-old who had undergone orthopaedic surgery, a four-year-old with a tonsillectomy, and a third child who received codeine in a cough suppressant.

A search of U.S. Food and Drug Administration data revealed 10 child deaths and three cases of severe respiratory depression attributed to codeine between 1969 and 2012, the report said.

“While the number of fatalities and cases of respiratory depression are small compared to the number of doses administered over many decades of use, it’s important we still draw attention to the fact that codeine is not an ideal medicine to treat pain,” Glatter said.

Some hospitals already have responded by removing codeine as an option for pain relief.

“In the health system where I work, the use of codeine has been essentially eliminated for the exact safety concerns that were mentioned here,” said Dr. Michael Grosso, medical director for Northwell Health’s Huntington Hospital in Huntington, N.Y.

Unfortunately, there are few other safe alternatives for children that are very effective. Doctors mainly rely on acetaminophen, ibuprofen or NSAIDs like aspirin to treat children’s pain these days, Tobias said.

Because these over-the-counter painkillers are less effective than narcotics, doctors urge parents to start dosing their children prior to any sensation of pain following surgery, and to give them around the clock every six hours for the first 48 hours after surgery, Tobias said.

Doctors can resort to oxycodone, fentanyl or Percocet (oxycodone and acetaminophen) to control severe pain, although those drugs should be reserved for extreme cases, said Dr. Amy Sniderman, a paediatrician with the Cleveland Clinic.

“They’re a little more predictable,” Sniderman said. “You could start with a small dose and see how a child reacts to it, and be comfortable that you can predict how the child is going to respond to it.”

However, it’s rare that children will require these more powerful painkillers, Sniderman said.

“In day-to-day general paediatrics, there’s no reason for me to be prescribing these on a regular basis,” she added.