Wednesday, April 23rd, 2014
Doctors are continuing to prescribe codeine to children despite nearly two decades of warnings against its use, according to new research published in the journal Pediatrics. More from CNN:
Every year, there are up to 870,000 prescriptions of codeine written for children in emergency rooms in the United States.
And that’s a huge danger, because the narcotic can have particularly powerful effects on children. So powerful that the American Academy of Pediatrics issued guidelines against its use in 1997. Yet, despite those guidelines, a new study in the journal Pediatrics has found that little has changed in codeine prescribing habits.
Study author Dr. Sunitha Kaiser and her colleagues evaluated the National Hospital and Ambulatory Medical Care Survey database for emergency room visits of children between the ages of 3 and 17 from 2010 through 2010. They found found that in the nine years evaluated, the percentage of codeine prescriptions dropped very little – from 3.7% to 2.9%.
Codeine can be a particular threat to children, because they can metabolize it very differently than adults. Up to a third of all children don’t process it efficiently, so that they need more than a standard dose. Another 8% of children metabolize it too quickly, meaning a standard dose can result in a fatal overdose.
“Codeine is notorious for rashes, hives, vomiting in kids, and constipation. You can be allergic to it,” says Dr. Alan Woolf, director of the Pediatric Environmental Health Center at Boston Children’s Hospital. Woolf wrote an accompanying editorial titled “Why Can’t We Retire Codeine?” in the same issue of Pediatrics.
Kaiser and her colleagues found that children between the ages of 8 and 12 were most likely to be prescribed the drug. While coughs and colds were commonly cited as a reason for codeine, the AAP’s guidelines specifically state “no well-controlled scientific studies were found that support the efficacy and safety of narcotics (including codeine).”
“Codeine’s been around a long time. You know, just like many other drugs, there’s complacency about it. Because it has such name value, people assume it’s safe. … And I don’t think a lot of practitioners, and a lot of (the) public, makes the connection between codeine and narcotic,” says Woolf.
Image: Pills, via Shutterstock
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Tuesday, May 1st, 2012
As many as one baby per hour is born already addicted to opiate painkillers, according to a new study published in the Journal of the American Medical Association. CNN.com reports:
By 2009 there were more than 13,000 babies born with neonatal abstinence syndrome, a withdrawal syndrome that occurs in some babies after being exposed to a class of painkillers, called opiates, while in utero, according to the study published Monday.
“That’s about one baby per hour,” said Dr. Stephen Patrick, lead author of the study, which was published online in the Journal of American Medical Association. “We were surprised by it. That’s a startling increase.”
Perhaps more startling – that one baby per hour figure marks about a three-fold increase in the number of babies born with NAS since 2000; and during the same time period, opiate use among expectant mothers was also jumping, increasing nearly five-fold.
“There has been an incredible increase in the number of opiate pain relievers prescribed in the U.S.,” said Patrick, a fellow in the University of Michigan’s Division of Neonatal-Perinatal Medicine. ”We think that might be part of the increase we are seeing.”
Image: Pregnant belly, via Shutterstock.
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Thursday, November 3rd, 2011
Children who have appendectomies or broken limbs are not given adequate narcotic pain medication, which leads to more hospital re-admissions than necessary, a new study in the Journal of Pediatric Surgery has found.
Thirteen percent of kids under age 18 who had had appendectomies reported pain that lingered for months, CNN.com reports. “Children are not being given enough pain medication, and they’re suffering needlessly,” Dr. Zeev Kain, senior author of the study and a pediatric anesthesiologist at the University of California, Irvine, told CNN.
The issue is two-f0ld, researchers found, a combination of doctors being reticent to send powerful pain medications home with parents, and parents who are nervous about giving their children the painkillers. But the study’s authors say that if doctors educate parents and write short-term prescriptions, and if parents carefully follow their doctors’ instructions about proper use of the drugs, their children can experience significant pain relief with minimal risk.
CNN offers advice for parents on how to manage post-surgical pain in children:
Pediatric pain experts have these tips for parents:
1. Ask your doctor about pain medication before your child leaves the hospital
If you think your child is in pain or will be in pain once you return home from the hospital, ask about pain medication.
“And if your child was on something for pain in the hospital, ask why they’re not continuing it when they go home,” Petitti advises.
2. Ask your doctor when to give the medication
Ask if you should give your child medication before the pain starts or only if they’re in pain, or if you should give the medication before your child tries to do a physical activity such as walking.
“You need to be really aggressive in terms of asking questions,” Kain advises.
3. Fill out your child’s prescription before you get home
When you arrive home with a sick child after a surgery or visit to the ER, it’s often tough to leave that child to go get the medication. Kain advises filling the prescription on the way home or at the hospital pharmacy if your hospital has one.
4. Recognize when your child is in pain
Once you get home, remember that a child won’t always cry, scream, or complain when they’re in pain, pediatric pain experts say. Some children in pain become quiet and withdrawn or have trouble eating or sleeping.
Unfortunately, both parents and doctors sometimes miss the pain in the quiet kids.
A 2008 study titled “The Squeaky Wheel Gets the Grease” showed that a day after having a broken limb treated in the emergency room, 20% of children received no pain medication, and 44% received only one dose. The children who were most likely to get medication were those who were loud and cried a lot.
Children in certain ethnic groups may be less likely to say they’re in pain because their culture places a high value on appearing stoic. Some studies have shown that Hispanics, for example, are less likely to talk about pain and ask for medicine.
5. Think about other ways to address the pain besides drugs
Alternative methods such as aromatherapy, acupuncture and music can be extremely helpful for kids in pain, Kain says.
Another technique is particularly powerful: distraction.
“You should definitely acknowledge your child’s pain by saying something like ‘Poor baby, I know it hurts to move, but then you should quickly move on to a solution,” Kain says. “You can say ‘let’s go for a drive’ or ‘let’s read a book’ or ‘let’s plan your birthday party together.’ Don’t just let your child lie there miserably on the sofa.”
(image via: http://www.123rf.com/)
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