There are health risks for children who are given codeine for coughs or pain.

“Last year, the U.S. Food and Drug Administration convened an advisory panel to consider the use of codeine specifically for suppression of cough and found little evidence of benefit,” said Dr. Randall Flick, director of Mayo Clinic Children’s Center and a member of the panel.

In fact, codeine can cause more problems in kids than it solves. “Over the past few years, several deaths have been associated with the use of codeine in children, typically, but not always, after tonsillectomy,” Flick said.

“In order to provide pain relief, codeine must be converted by the body into morphine. Depending on genetics, some people convert none of the codeine dose to morphine, while others convert a large amount very rapidly.”

That means that some children receive no benefit, while others, called ultrarapid metabolizers, are placed at risk for overdose despite having received the recommended dose.

According to Flick, alternative pain medications include other opioids that do not share the same genetically based problems as codeine and non-opioid pain medicines such as ibuprofen, acetaminophen or other similar medicines.

“Parents should avoid using over-the-counter, codeine-containing products such as cough medicines,” he said. “They should discuss alternatives with their doctor when prescribed codeine for pain or cough.”