Restricted use of codeine in children may be having unintended consequences, according to doctors at the Royal London Hospital (reports Christine Clark).

A poster presented at the recent British Society of Haematology conference in Edinburgh showed that, after codeine had been withdrawn for the under-12s, admissions for children experiencing acute pain crises in sickle cell disease (SCD) increased sharply. In July 2013 a MHRA update recommended that codeine should only be used for pain relief in children over the age of 12 years.

This followed a series of fatalities in North America in children given codeine post-adrenotonsillectomy. The cases were believed to be related to duplications of the CYP2D6 gene resulting in ultra-fast conversion of codeine to morphine. This recommendation removed a mainstay of analgesic treatment for SCD crises in the under-12s.

Without codeine the only analgesics available to under-12s for home treatment of vaso-occlusive crises are NSAIDs. Examination of patient records at the Royal London Hospital for the three-month period April to June in 2013 and 2014 showed that the number of admissions increased from 31 in 2013 to 43 in 2014. Readmissions increased from three to 10.

The change in home pain management for mild-tomoderate crises could have an impact on school attendances, employment of parents and care of siblings, the researchers suggest.