Codeine has been widely used in the past to treat coughs and manage pain in kids, but the drug just received its strongest stamp of disapproval yet. In a statement from the American Academy of Pediatrics with the firmly worded title Codeine: Time to Say “No,” pediatricians are now stating that there is never a reason to use codeine. Citing little evidence that codeine is effective in treating coughs and an increased belief that some children don’t respond to codeine for pain treatment for and after procedures such as tonsillectomies, the group warns consumers that there are documented and dangerous potential side effects to using codeine. In 2013, FDA gave codeine a “black box warning” and in recent years the European Medicines Agency has also recommended against its use for cough, cold, and pain treatment for children under the age of 12 (or between the ages of 12 and 18 for children with breathing issues). Despite these warnings, codeine is available in 28 states and Washington D.C. without a prescription and is also still prescribed by many doctors. Part of the problematic nature of codeine is that the substance is processed or metabolized differently by various groups of people. For example, my daughter was born in Ethiopia, which has a high prevalence of “ultra rapid metabolizers,” determined by certain genotypes. Giving her codeine could cause problematic slowdowns in her breathing despite being given medicine within the “normal range.” As a precaution, the AAP is recommending that codeine not be used in any situation for children and that parents shouldn’t assume that because it is available over the counter it is safe for their child. With cold, cough, and flu season coming up, it’s a warning we should all heed.