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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Cough vs. Codeine

I love it when I get emails like this in the early innings of the day:

Good morning, I am attaching an article about codeine. On several occasions this past week parents have requested prescribed cough medicine. The Dr did a great job explaining why he does not prescribe them, right on point with this article in today’s Newsday.

Have a great week.

Catherine

It’s blog day and sometimes I‘m not totally hooked on a topic.  I was starting out with:

Zika.  Nooooooo, not today. The legislators are being too annoying.

Flu.  Meh.  I’ve done some posts about that already and in a few weeks I’mma be all over that like a bad rash.

And THEN I got the email above from one of my colleagues.  Along with an article.  And I thought: yep, gonna go there.  Gotta talk about cough medicine, everyone.

 

If you haven’t heard by now, prescribing cough medicines for kids, and suggesting over the counter cough and cold remedies for that matter, are NOT recommended.

newsday

via Newsday

The one medicine that has recently been specifically called out by the American Academy of Pediatrics is codeine, an opiate (yup!) that really can have bad effects on slowing down breathing, especially in the subset of people who, by mere genetics, happen to be rapid metabolizers of the drug. The codeine works by being broken down inside your liver and turning into morphine, which is another controlled substance & pain reliever.  Not too long ago, codeine was thought to be useful as cough medicine.

There’s been a lot of research done on this, concluding that there’s just no solid evidence that they work,

and they can have potentially harmful side effects, like abnormal heart rhythms and depressed breathing.  Breastfeeding moms who are using codeine may also potentially increase opioid toxicity in your baby – speak with your doctor if you have concerns. Codeine used to be found in over the counter cough remedies but has been removed due to its negative effects.   Then for awhile physicians would prescribe codeine syrup to help with cough.  No more.  Just not worth the risk.   Better to cough than to NOT BREATHE AT ALL. I also like to remind patients and parents that the cough is the body’s way of getting RID of an infection, so an effective cough is actually your body takin’ care of business.  Let’s not suppress that.

I totally get that when your child is coughing a lot they are uncomfortable, you are uncomfortable, everyone is uncomfortable and we all want to do something, anything, to help it get better.  But let’s respond to the data and do the best and safest thing for our kids.  No cough medicine.  And definitely NOT an opiate like codeine.

So what CAN you do?

• Give pain reducers for those sore chests and throats, like acetaminophen or ibuprofen.  A lot of people think that if there’s no fever then these medicines don’t help.  They do!  They make kids feel better.

WTP-Hunnypot

• For kids over a year old, a little bit of honey (2-3 tsp) has actually been shown to have some benefit (research!).  Many people recommend mixing it in with a little decaffeinated tea (not too hot).

• Make sure the air in the environment isn’t too dry.  Sometimes a walk outside or a humidifier in the bedroom or sitting in a steamy bathroom can help break that annoying cough cycle.

• Try to be patient. The hardest one of all.

 

 

So, Cathy and I hope you’ll join the bandwagon of folks who don’t give or request cough medicine for their kids, even though it’s tempting.  We want everyone to get well soon, and we know you do too! But first and foremost, we want to DO NO HARM.

 

 

Keep reading! Just For Good Measure

 

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