National guidelines recommend that the narcotic, codeine, should not be prescribed to children; however, a new study has found that this recommendation is often not followed. The study was published online on April 21 in the journal Pediatrics by researchers at the University of California San Francisco (San Francisco, California) and the Hospital for Sick Children (Toronto, Ontario, Canada).
The researchers conducted a study to determine what impact the recommendations against prescribing codeine to children had on the prescribing practices to children in US hospital emergency departments. They evaluated changes over time and attempted to determine factors associated with codeine prescription.
The researchers conducted an analysis of emergency department visits for patients aged 3 to 17 years in the nationally representative National Hospital Ambulatory Medical Care Survey from 2001 through 2010. They identified annual rates of codeine prescriptions and evaluated trends over the study period. They conducted s statistical analysis to determine characteristics associated with codeine prescription as well as a time-series analysis to evaluate changes in prescriptions for upper respiratory infection or cough associated with two 2006 national guidelines recommending against its use for these indications.
The investigators found that the proportion of emergency department visits (189 million visits) with codeine prescription decreased from 3.7% to 2.9% during the study period. The prescription rate was higher for children aged 8 to 12 years and among healthcare providers outside the northeast. The prescription rates were lower for children who were non-Hispanic African American, or were on Medicaid. The 2006 guidelines were not associated with a decrease in codeine prescriptions for cough or upper respiratory infections visits.
The authors concluded that they found a small decline in codeine prescription over 10 years; however, the used of codeine for a cough or upper respiratory infection did not decrease after national guidelines were published that recommended against its use. They noted that more effective interventions are needed to prevent codeine prescription to children.
The American Academy of Pediatrics notes that a cough is usually a mild symptom of the common cold and coughing serves the beneficial functions of clearing airways of obstructing or irritating material; thus, the clearing of secretions is probably beneficial. In children who suffer from lung problems such as asthma, chronic obstructive pulmonary disease, chronic bronchitis, or cystic fibrosis, the cough reflex serves to keep the airways clear by clearing excessive secretions. Therefore, cough suppression in children with these conditions may be not only counterproductive but also directly harmful.