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What Parents Should Avoid after Their Child’s Tonsillectomy

Tim Boyer's picture
Say "no" to codeine recommed tonsillectomy experts

Tonsillectomies are no fun for the child or the parent because of the pain that follows surgery for the next several days. Find out now why some health experts believe that parents should avoid what has been the normal course of treatment for many years.


According to a recent CBS News report, the use of codeine in treating a child’s pain after a tonsillectomy poses risks that should cause parents some concern. Although for decades acetaminophen combined with codeine has been used to treat post-operative pain in children as a safe and effective treatment, the American Academy of Pediatrics is repeating its past warnings about prescribing codeine for children because of reports of deaths and the increased risks for breathing difficulties; and, the argument that research fails to show that codeine works to relieve post-operative coughing that can interfere with healing.

The Risk Codeine Poses

The problem with prescribing codeine for children is that codeine is a prodrug with little inherent pharmacologic activity on its own. But when it reaches the liver, it is then metabolized into its active form as morphine, which gives codeine its analgesic effect. However, it turns out that not all children metabolize the drug in the same way, which consequently causes individual patient responses to codeine that varies from no effect to high sensitivity.

In fact, drug surveillance observations have documented cases of unexpected respiratory depression and death in children who were afterward discovered to be ultra-rapid metabolizers of codeine. According to CBS News, a FDA review found 21 codeine-related deaths in children younger than 12 and 64 cases of severe breathing problems over the past five decades.

The Answer

Unfortunately, there is no one answer to address everyone’s concern and views of the safety and applicability of codeine for treating children in pain. Rather, those opposed to the continuing use of codeine call for more research to be done to assess the risks and benefits of codeine and non-opioid painkillers for children.

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What a parent can do as an alternative to codeine is to provide their child with physician-recommended weight-dosed amounts of either acetaminophen or ibuprofen after a child’s tonsillectomy. Ibuprofen provides excellent pain control and has not been shown to increase the risk of postoperative bleeding such as that seen with aspirin.

Otherwise, a lot of TLC, the always promised, “All the ice cream you want,” and constant feeding with ice chips to keep the child hydrated and ease the soreness in their tender throat.

For more options on what a parent can do for their child, here is an article on how that Trying Acupuncture May Be Helpful for Treating Tonsillectomy Pain in Kids.


CBS News “Pediatricians warn against codeine in kids' prescriptions

Clinical Report--Codeine: Time To Say “No” Pediatrics Sept.2019; Joseph D. Tobias, Thomas P. Green, Charles J. Coté, Section on Anesthesiology and Pain Medicine, Committee on Drugs.

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