The American Academy of Pediatrics (AAP) is now calling for restrictions on use of codeine, especially in patients under the age of 18. The Academy also urges health providers and parents to stop giving codeine to children, advocating for more education about its risks. The AAP conveyed that there is a continued use of the drug in pediatric settings and this common painkiller has been linked to life-threatening or fatal breathing reactions.

Codeine is an opioid drug used in prescription pain medicines and over-the-counter cough formulas. It is converted by the liver into morphine. Because of genetic variability in how quickly an individual's body breaks down the drug, it provides inadequate relief for some patients while having too strong an effect on others. Due to rapid metabolism, certain individuals, especially children and those with obstructive sleep apnea may experience severely slowed breathing rates or even die after taking standard doses of codeine.

U.S. FDA and WHO documented that the drug still is available without prescription in over-the-counter cough formulas from outpatient pharmacies in 28 states and the District of Columbia. In addition, it still is commonly prescribed to children after surgical procedures such as tonsil and adenoid removal. More than 800,000 patients under age 11 were prescribed codeine between 2007 and 2011, according to one study cited in the AAP report. Otolaryngologists were the most frequent prescribers of codeine/acetaminophen liquid formulations (19.6%), followed by dentists (13.3%), pediatricians (12.7%) and general practice/family physicians (10.1%) respectively.

This new clinical report outlines potential alternatives to provide pain relief in children but admit that there is a lack of safe painkillers available to pediatric use. According to Dr. Joseph D. Tobias, the report’s lead author, "Effective pain management for children remains challenging because children's bodies process drugs differently than adults do."