Codeine and your child

With cough and cold season underway, you need to be aware that a time-honored, go-to treatment for children’s coughs is no longer recommended. The FDA is investigating the safety of codeine cough syrup for children younger than 18, and the American Academy of Pediatrics now recommends against codeine for children with coughs.

Does codeine stop cough?

Cough is one of the most common symptoms children present, and over-the-counter cough and cold medications with codeine have been prescribed for decades to stop coughing. Children’s codeine cough syrup and cold remedies are still available without prescription in 28 states and the District of Columbia. But while codeine cough syrup may work well for some adults who have a cough, science now knows that it works differently in children – and can cause serious problems.

What’s the problem with codeine in children?

Codeine alone provides little help with coughing. It must be chemically altered by the liver to be effective. And that’s where the problem lies. When the liver processes codeine, it is altered into its active form, which is morphine. Children’s livers convert codeine into higher-than-normal levels of morphine. Morphine can significantly decrease breathing in infants and children. And children who already have breathing problems are at higher risk.

If you have been prescribed codeine cough syrup or are using an over-the-counter cough medicine containing codeine for your child, double-check with your physician about whether this is safe for your child. If your child shows these signs, seek immediate medical attention:

• Unusual sleepiness, such as being difficult to wake up
• Disorientation or confusion
• Labored or noisy breathing, such as breathing shallowly with a “sighing” pattern or deep breaths separated by abnormally long pauses
• Blueness on the lips or around the mouth

What about other cough medicine ingredients?

If you read the ingredient labels on children’s cough and cold products, you may see dextromethorphan and diphenhydramine. The American Academy of Pediatrics advises against the use of cough products containing dextromethorphan for children under 18 and for products containing diphenhydramine for children age 4 or younger.

Cough treatments without codeine

A chronic cough makes your child uncomfortable and interrupts sleep, so it is understandable that you want to treat it. Here are cough treatment recommendations that are safe for children:

• Age 3 months to 1 year: Give 1 to 3 teaspoons of warm apple juice or lemonade up to four times a day.
• Age 1 year and older: Give ½ to 1 teaspoon of honey as needed. If you don't have any honey, you can use corn syrup. Do not give honey to children younger than age 1.
• Age 6 and older: Hard candy can be used to coat the throat and relieve cough.

Learn more about common causes of coughs and when to call the doctor.