The American Academy of Pediatrics (AAP) has urged both parents and doctors to stop giving codeine to children due to a link with life-threatening risks to breathing.

Codeine is contained in a number of over-the-counter cough medicines and painkillers that should be avoided by children under the age of 18. Converted in the liver to produce morphine, it can be an effective way to treat pain but in some people, especially children, it can be too strong a reaction resulting in problems with respiration and could potentially lead to fatal consequences.

Children can have a difficult time metabolizing the codeine due to the amounts of enzymes present in the liver and therefore other forms of pain relief such as Ibuprofen, Motrin or Tylenol be administered instead.

Despite the AAP’s urgent call to ban codeine from popular non-prescription medicines such as cough syrup, they are still widely available for people to purchase over the counter and without adequate healthcare advice. Not only that, but doctors still advise children to take these medicines when, for example, they’ve had tonsils and adenoid removed. This equates to nearly 19.6 percent of codeine prescribed to 800,000 children between 2007 and 2011 – 13.3 percent were prescribed through dental treatments.

“There is no benefit to codeine and potential risk, and it makes little medical sense to be using this in children,” said Dr. Rebecca Rosenberg, assistant pediatrician at NYU Langone Medical Cente but not involved in the study. “Codeine is also not that effective as a pain medication. Very few people respond to it.”

The World Health Organization, European Medicines Agency and the U.S. Food and Drugs Administration all agree that, despite the risk being small, codeine needs to be declared a risk for children after recording 64 cases of severe respiratory difficulties and 21 deaths in children between 1965 and 2015.

Details of the study by AAP can be found at their website.