Is Codeine Safe for Children?

More than half a million tonsillectomies are performed each year on children in the U.S. More than sixty percent of those children report significant pain in the days that follow. Acetaminophen with codeine is in widespread use for post-operative pain, but the U.S. Food and Drug Administration is now investigating the safety of codeine for post-operative pain relief in children following reports of three deaths in children related to its use after tonsil surgery.

Kids deserve pain relief, both for comfort and to speed up healing — pain negatively impacts breathing and kids are less likely to eat and drink after surgery when they are in pain, but there is no known benefit of acetaminophen with codeine over acetaminophen alone for post-tonsillectomy pain in kids.

Another option is ibuprofen, but many physicians are reluctant to recommend ibuprofen because of bleeding concerns. Interestingly, research hasn’t shown the dangers physicians fear.

Another alternative is acetaminophen with hydrocodone. It appears to be more effective and less risky than acetaminophen with codeine – especially if on a schedule, rather than waiting for pain to breakthrough.

Kids do deserve pain relief, but I see no reason to give codeine after tonsillectomy, when there are other, less risky options.

Published on: August 15, 2012
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Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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Is codeine safe for kids with G6PD deficiency? Thanks.