Despite warnings against its use, FDA, World Health Organization, and European Medicines Agency, codeine continues to be widely used for management of paediatric pain and cough in the U.S. In 2011, codeine was prescribed to more than 800,000 children younger than 11 years. Codeine is currently available in over-the -counter cough medicines in 28 states in US. Genetic variation in codeine metabolism can lead to excessive morphine levels in some children, and is a particular concern in those with sleep-disordered breathing.
Citing risk for respiratory depression or death, the American Academy of Pediatrics, in a clinical report, urges clinicians and parents to stop giving codeine to children. Among the limited alternatives for paediatric analgesia, other opioids are not recommended due to similar safety concerns or insufficient evidence about safety in children. Nonopioid options, chiefly…
