A Message from AAP President Fernando Stein, MD, FAAP


In the early hours of the morning, a dangerous bill that would have jeopardized health care for millions of children and families was narrowly defeated. The U.S. Senate voted 49-51 on legislation to repeal the Affordable Care Act, stopping the bill in its tracks and protecting health care coverage for the American people. The Academy’s response is here.

This was possible because of you. Pediatricians gave children a voice, and senators listened. Your efforts proved the remarkable impact a group of people can make when they come together and stand up for the voiceless – children whose lives were at stake, children who came to Washington with their families to share their stories because they knew what they had to lose, children who count on you to speak up for them in the walls of your clinics and the halls of the Capitol.

You did it. As an Academy, we are only as strong as the pediatricians, pediatric medical subspecialists and pediatric surgical specialists like you who advocated tirelessly and never gave up. I want to personally extend my thanks for every phone call, tweet, letter and op-ed. The collective outreach senators received from advocates like you helped build a foundation of opposition, making the vote as narrow and uncertain as it ended up being. We thank the leaders of AAP chapters, committees, councils and sections who never wavered.

Today, we pause and reflect on what worked, then look forward to the next steps – bipartisan solutions for children and families. Any health care legislation that advances in Congress should build on the historic progress we’ve made and ensure that children can continue to access health care coverage that meets their needs at a price their families can afford.

In addition, the Children’s Health Insurance Program (CHIP) is up for renewal and the clock is ticking before the September 30 deadline to extend its funding. CHIP is a bipartisan success story, and lawmakers have an opportunity to make good on their promises and keep the program strong for the millions who rely on it for health insurance. We have our work cut out for us, but I know pediatricians are up for the challenge.

For now, there is one thing you can do – please call your U.S. senators today. You can see how your senators voted on the legislation here.

If your senators voted “no” to the Health Care Freedom Act, please call them and say thank you, especially if you are from Arizona, Maine or Alaska, where Sens. McCain, Collins and Murkowski broke from their party to vote against the bill. If your senators voted “yes,” use the opportunity to reassert the importance of protecting children’s health care coverage in future discussions, including by renewing CHIP. If you have U.S. senators, the phone numbers for their DC offices are listed below:

Sen. Joe Manchin (D) (202) 224-3954
Sen. Shelley Capito (R) (202) 224-6472

Thank you again for all that you do. I am humbled and inspired every day by your dedication to children, and look forward to continuing this important work together.


Fernando Stein, MD, FAAP
AAP President

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Do not use codeine, tramadol in children: FDA

Codeine and tramadol should not be used to treat pain or cough in children younger than 12 years as they could be fatal, the Food and Drug Administration (FDA) said Thursday.

The FDA unveiled several changes to the labels of the medications to protect children, adolescents and infants being breastfed.

“We are requiring these changes because we know that some children who received codeine or tramadol have experienced life-threatening respiratory depression and death because they metabolize (or break down) these medicines much faster than usual (called ultra-rapid metabolism), causing dangerously high levels of active drug in their bodies,” Douglas Throckmorton, M.D., deputy center director for regulatory programs in the FDA’s Center for Drug Evaluation and Research, said in a statement.

The FDA is adding the following new restrictions to the warning labels of codeine and tramadol:

  • Codeine is contraindicated to treat pain or cough, and tramadol is contraindicated for treating pain in children under 12.
  • Tramadol is contraindicated for treating pain after surgery to remove tonsils and/or adenoids for children under 18. Use of codeine for this purpose was placed under the same restriction in 2013.
  • Codeine and tramadol are not recommended for use in adolescents ages 12-18 who are obese or have conditions such as obstructive sleep apnea or severe lung disease.
  • Mothers should not breastfeed when taking codeine or tramadol.

Since 1969, codeine has been linked to 64 cases of serious breathing problems, including 24 deaths in children and adolescents. Tramadol is not approved for pediatric use but has been tied to nine cases of serious breathing problems, including three deaths in children and adolescents, according to the FDA. There also have been cases of breathing problems in breastfed infants whose mothers were taking codeine.

In September 2016, the Academy released a clinical report Codeine: Time to Say “No” that expressed concerns about the dangers of codeine use in children and called for more formal restrictions.

The FDA recommends physicians use other medications for treating cough and pain. Officials also encouraged parents to pay close attention to the ingredients in medication they give their children and seek immediate medical attention if children taking the restricted medications experience difficulty breathing, confusion, unusual sleepiness, trouble breastfeeding or limpness.