Listen up parents, codeine ― an ingredient commonly found in your child’s cough syrup ― could pose health risks for him. In a statement issued last month, The American Academy of Pediatrics (AAP) urged parents and healthcare providers to stop giving prescription pain medicines and over-the-counter (OTC) cough formulas containing codeine to kids younger than 18 years old. Codeine is an opioid ― a compound resembling opium in addictive properties ― that’s used to relieve pain.
Explains Dr Michael Wong, a deputy medical director at Raffles Medical, “It is often found in cough and cold medication or combined with paracetamol to enhance its pain-relieving properties and is used to treat mild to moderate degrees of pain, as well as suppress an acute cough.”
When codeine enters our body, enzymes in our liver transform it into morphine to dull the pain. However, its effectiveness depends on how much enzyme your body produces ― too little and you receive absolutely no relief. Too much and it can result in adverse effects such as slowed breathing rates (also known as respiratory depression) and even death after a standard dose.
Children’s bodies process drugs differently than adults and the enzyme in their bodies changes as they grow, so codeine presents very little benefit to them while still carrying potential risks.
Over the past 50 years, the Food and Drug Administration has reported 64 cases of severe respiratory depression and 24 codeine-related deaths. Of this number, 21 involved children under age 12.
“Children’s bodies process drugs differently than adults and the enzyme in their bodies changes as they grow, so codeine presents very little benefit to them while still carrying potential risks.”
Although its risks are well-documented, Dr Wong notes that in Singapore, there are seven registered pain-relieving products with codeine as an ingredient and 22 products to treat cough and cold in children and adolescents that contain codeine. SmartParents has questions for Dr Wong about a topic that has many parents concerned…
Dr Wong, do you agree with the AAP that codeine can be harmful to young children?
Yes, it does pose health risks to children. Some side effects of codeine include drowsiness, dizziness, headaches, blurred vision, nausea/vomiting and constipation. With prolonged use, the child could also develop a drug dependence and in the worst case scenario, respiratory depression.
The liver CYP2D6 enzyme in our body, which metabolises a quarter of all prescribed drugs ― including codeine ― converts codeine into its active metabolite, morphine, which provides its analgesic effect. Some are able to metabolise codeine to morphine more rapidly, predisposing them to higher levels of morphine in their body. Should they be rapid metabolisers, nursing mothers who take codeine may also produce breastmilk containing higher than expected levels of morphine.
Although it’s widely used as a cough suppressant, studies have shown that codeine is no more effective than a placebo in suppressing cough caused by either upper respiratory disorders.
How often do doctors in Singapore prescribe cough syrups and pain relievers with codeine in them to young kids?
Cough preparations containing codeine (or a codeine-like compound like dextromethorphan) are widely prescribed by many physicians to children (and adults) for the suppression of cough. It is often found combined with a decongestant or antihistamines.
As an analgesic, the prescription of codeine to children is probably less popular because many don’t favour its sedating effect and also due to alternatives such as ibuprofen or paracetamol, which are generally effective.
Click to find codeine-free cough treatments for your tot…
So, what should parents know when buying OTC cough or pain relief meds for young kids?
OTC drugs should be used conservatively and it’s important to note that these medication may sometimes produce exaggerated and sometimes, paradoxical effects on children. Most coughs and colds clear up without any treatment. Although caregivers frequently seek interventions to suppress cough, they should understand that coughing clears secretions from the respiratory tract. So, suppressing the cough may result in retention of secretions which may potentially cause harm by obstructing the airways.
OTC cough and cold medications have been associated with fatal overdose in children younger than 2 years of age. These meds also have the potential for enhanced toxicity in young children because their metabolism, clearance, and drug effects may vary according to age. Plus, safe dosing recommendations have not been established for children.
Symptoms of the common cold need not be treated unless they bother the child (eg, interrupting sleep, interfering with food intake or causing discomfort). Thus, OTC medications for cough and cold are not recommended for the common cold in children younger than 6 years of age and best avoided even for children 6 to 12 years.
“Pain-relief medication such as paracetamol and ibuprofen are generally safe options for young children, provided that they have not had prior adverse reactions to them.”
Could you recommend some codeine-free cough syrups/pain relief meds for young kids?
Pain-relief medication such as paracetamol and ibuprofen are generally safe options for young children, provided that they have not had prior adverse reactions to them.
What other options do parents have to ease their child’s cold symptoms parents if they don’t want to medicate them?
Maintain adequate hydration to thin secretions and soothe the respiratory mucosa. Drinking warm liquids such as tea and chicken soup as they have a soothing effect, will increase the flow of nasal mucus and loosen respiratory secretions. The warmed liquids should be appropriate for the age of the infant or child.
Topical saline may be beneficial, is inexpensive and unlikely to be harmful or impede recovery. Applying saline to the nasal cavity may temporarily remove bothersome nasal secretions, clear mucus and help with decongestion. Side effects may include mucosal irritation or nosebleeds.
You can avoid codeine by offering these alternative remedies…
Woods Peppermint Cough Syrup ($6.40/100ml)
Contains active ingredient guaiphenesin, an expectorant that thins and breaks down the phlegm that clings to the air passage walls. The phlegm is then dislodged, so it’s easier to flush out of the body.
Robitussin PS ($10.70/100ml)
It relieves chest and nasal congestion (contains guaiphenesin to loosen phlegm). Has a raspberry with menthol flavour.
Nin Jiom Pei Pa Koa ($6.70/300ml)
Made with a blend of herbal ingredients, including pomelo peel, ginger, licorice root, bitter apricot kernel, menthol and honey. Relieves minor inflammation of the throat, soothes pain and also clears phlegm.
All products can be found at Watsons stores.
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