By Dr. Sarah Lazarus
Cough and cold medicines are commonly used, and can be dangerous. Per the FDA (Food and Drug Administration) website, these products include decongestants, expectorants, antihistamines, and antitussives. These medicines are often used in an attempt for parents to relieve their children’s coughs, colds, and allergies.
Multiple studies have shown that there is little clinical advantage between the use of placebos and cold and cough medicines in very young children. These studies have shown that cough and cold medicines do not improve sleep, or quiet cough. In fact, the dangerous side effects outweigh any benefits.
Thousands of children are treated in emergency departments every year due to secondary side effects from cough medicines. Ingredients such as pseudoephedrine, have even been linked to a number of deaths. Reasons children may experience side effects from these medications may include receiving too much medication, receiving medication too frequently, or receiving multiple cough medications containing the same ingredient.
The FDA recommends (also stated as warnings per their website) that over-the-counter cough and cold products not be used in infants or children under the age of two years. In 2008, manufacturers voluntarily re-labeled cough and cold products to state “do not use in children under four years of age”. Unfortunately, parents of children in this age range still report use of this medication. In a study done at Children’s Healthcare of Atlanta in conjunction with Emory University, the authors found that out of 65 caregivers of children under the age of six surveyed in an urban pediatric emergency department, 82% stated they would treat their children’s current symptoms with cough or cold medicines. In the demonstration portion of the study, 70% of caregivers chose medicines containing phenylephrine and 58% of caregivers would have dosed medications inappropriately per dosing recommendation labels in spite of having the bottles with associated instructions readily available. Interestingly, 20% of caregivers stated that they had previously received recommendations to give cough or cold medicines from health care providers (pediatricians, nurses and pharmacists). The majority of the potential dosing errors that were made involved giving these medications to children who were younger than the label’s recommended age for the product.
Parents and caregivers should follow the directions on labels closely regarding the indications, use and delivery of these medicines. It is important that parents and caregivers only use the measuring spoons or cups that come with the medicine. Often, parents will use a teaspoon, tablespoon or other household object to measure out these medications, and it is important to note that these are not calibrated measuring devices and may deliver inaccurate or inappropriate amounts of these medicines. These medications do not quiet cough, do not improve sleep, and are not any better than a placebo (non-active medicine) for children in the improvement of cough and cold symptoms. Per the American Academy of Pediatrics, other alternatives to cold and cough medicines include honey (2-5 ml as needed by mouth) for children over the age of twelve months. Under twelve months, honey is not considered safe (due to risk of botulism). Using a bulb suction with or without saline drops, may also help with congestion in children even younger than 12 months. Often, cold and cough symptoms are caused by viruses, so symptoms should improve in about 5-7 days without any medications.