Physicians Continue to Prescribe Codeine for Children, Even When Safer Alternatives are Available

Physicians continue to prescribe codeine to children in emergency rooms despite knowing of its adverse effects and availability of safer alternatives.

Codeine is a drug prescribed by physicians for treating mild to moderate pain and suppressing cough. While the drug has proved to be effective in adults, children might incur adverse side effects of codeine, depending on how they process it. According to statistics, one third of children who receive the drug show no symptom relief after taking it. However, one in every 12 children treated with codeine can accumulate toxic amounts causing slow breathing and possible death.

Safer alternatives to this drug like ibuprofen and hydrocodone are also available. However, despite being aware of this, doctors continue to prescribe codeine for children, according to University of California - San Francisco researchers.

"Despite strong evidence against the use of codeine in children, the drug continues to be prescribed to large numbers of them each year," said Sunitha Kaiser, UCSF assistant clinical professor of pediatrics in a press release. "It can be prescribed in any clinical setting, so it is important to decrease codeine prescription to children in other settings such as clinics and hospitals, in addition to emergency rooms."

To gain a better understanding about the frequency at which codeine was being prescribed to children in the U.S. emergency rooms, researchers from the university examined data from the National Hospital and Ambulatory Medical Care Survey, which gathered information about codeine prescriptions to children ages 3-17 during U.S. emergency room visits from 2001-2010.

Researchers noted that though codeine prescriptions to children decreased from 3.7 percent to 2.9 percent during the 10-year period, as many as 559,000 to 877,000 codeine prescriptions a year were still being made.

Researchers also found that codeine prescriptions were higher in children aged between 8 and 12 and in regions outside the North East. It was lower for non-Hispanic black children or those with Medicaid.

"Further research is needed to determine the reasons for these lower rates so we can reduce codeine prescriptions to all children," Kaiser said. "Many children are at risk of not getting any benefit from codeine, and we know there are safer, more effective alternatives available. A small portion of children are at risk of fatal toxicity from codeine, mainly in situations that make them more vulnerable to the effects of high drug levels such as after a tonsillectomy."

Many health organizations have advised against using codeine for children. In 1997, the American Academy of Pediatrics issuedguidelines warning of the drug's dangerous effects on children and the lack of documented evidence that codeine is actually effective in treating coughs and colds. The same guidelines were reaffirmed by the organization in 2006. That same year, the American College of Chest Physicians advised against using codeine when they issued a set of guidelines for treating pediatric cough.

University of California - San Francisco researchers found that these guidelines were not effective in bring down the rate of codeine prescriptions for children.

The AAP suggests using dark honey to treat children with cough as it is safer and more effective than any over-the-counter medication.

Findings of the study were published online in Pediatrics. The work was supported by an award from the National Institute for Children's Health and Human Development.

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