A 7-year-old boy arrives at urgent care with his father. The boy fell off a trampoline onto his outstretched hand. His right elbow is swollen and has limited range of motion. The boy is crying and appears to be in significant pain as you examine him. You suspect he has a supracondylar fracture and decide to offer analgesia before sending him for x-rays. Which of these analgesics would be LEAST appropriate for this patient?
a. Ibuprofen
b. Acetaminophen
c. Acetaminophen with hydrocodone
d. Acetaminophen with codeine
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Answer: D. Ibuprofen and acetaminophen should be first-line medications for analgesia, with opioids reserved for use only if further pain control is required. Even when opioids are indicated, however, codeine-containing products should be avoided for all children aged <12 years, per the recommendations of the US Food and Drug Administration and the American Academy of Pediatrics. This is due to the risks of either inadequate analgesia or opioid overdose effects, including respiratory depression, which have been associated with codeine use in children.
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