From the Guidelines
No, an 8-year-old should not take hydrocodone unless specifically prescribed by a physician and administered under close medical supervision. Hydrocodone is a potent opioid analgesic that is rarely appropriate for children this age due to significant risks including respiratory depression, overdose, and potential for dependence. According to the FDA guidelines endorsed by an expert panel opinion in JAMA Surgery 1, codeine and tramadol, which are also opioid analgesics, are contraindicated to treat pain or cough in children younger than 12 years. While hydrocodone is not explicitly mentioned in this guideline, the risks associated with its use in children are similar to those of codeine and tramadol. For children, pain management typically begins with non-opioid alternatives like acetaminophen or ibuprofen at age-appropriate doses. If a child has severe pain requiring stronger medication, this should only be determined by a pediatrician or specialist who can calculate the correct dosage based on the child's weight, medical history, and specific condition. The child's breathing, heart rate, and other vital signs would need careful monitoring during treatment. Children metabolize medications differently than adults, making them more susceptible to side effects and complications. Parents should never give a child hydrocodone from an adult's prescription or without explicit medical direction, as this could result in serious harm or even death. Key considerations for the use of opioid analgesics in children include:
- Close medical supervision
- Calculation of correct dosage based on the child's weight, medical history, and specific condition
- Monitoring of vital signs during treatment
- Use of non-opioid alternatives as first-line treatment
- Avoidance of use in children younger than 12 years unless absolutely necessary and under close medical supervision, as recommended by the FDA guidelines 1.
From the Research
Hydrocodone Use in Children
- Hydrocodone is a prescription opioid licensed in the USA for the relief of cough and upper respiratory symptoms associated with allergy or cold in adults, but its use in children is limited due to safety concerns 2.
- A benefit-risk review of hydrocodone use in patients aged 6 to <18 years found no robust efficacy data for hydrocodone in the relief of cough and upper respiratory symptoms associated with allergy or cold in this age group, and the US Food and Drug Administration (FDA) has decided that hydrocodone-containing cough and cold medications should no longer be indicated for treatment of cough in patients <18 years 2.
- The American Academy of Pediatrics recommends that clinicians treat acute pain using a multimodal approach that includes nonpharmacologic therapies, nonopioid medications, and, when needed, opioid medications, but opioids should not be prescribed as monotherapy for children or adolescents who have acute pain 3.
- Codeine, tramadol, and hydrocodone have been associated with morbidity and death in children, secondary to respiratory depression, and clinicians are encouraged to prescribe safer alternatives such as morphine, ibuprofen, or paracetamol 4.
Safety Concerns
- Hydrocodone can cause harmful side effects in children, such as breathing problems, and there have been reports of fatalities in children who have taken hydrocodone-containing cough medicines 2.
- The use of opioids in children can also lead to opioid use disorder, poisoning, and overdose, and clinicians should be cautious when prescribing opioids to children and adolescents 3.
- Non-opioid analgesic regimens, such as acetaminophen and ibuprofen, can be effective in managing pain in children and may be a safer alternative to opioids 5.
Alternative Treatments
- Non-opioid medications, such as ibuprofen and paracetamol, can be effective in managing pain and cough symptoms in children, and may be a safer alternative to opioids 3, 4, 5.
- Clinicians should consider using a multimodal approach to pain management, including nonpharmacologic therapies, nonopioid medications, and, when needed, opioid medications, to minimize the risks associated with opioid use in children 3.