The Risks of Pediatric Cough Medicine

Mother giving daughter medicine

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A cough is one most frustrating symptoms of childhood illness. Not only can a bad cough keep kids up all night, if it's severe enough to distract classmates, coughing can even get them sent home from school.

While many over-the-counter-products are available, parents often wonder which treatment will work best (and is the safest) to quiet their child's cough. Here's what parents need to know about choosing the right cough medicine for their kids.

Cold and Cough Syrup Warnings

Warnings on cold and cough syrups typically state that the products should not be given to children under the age of four. Parents should not give give small children or infants pediatric cold and cough medicine that is designed for older children.

If your child is under the age of two years old, never give them cold and cough products with decongestants and antihistamines without asking their doctor.

Cough Syrups

Medicines that help quiet coughs (antitussive medicines) usually include one or more of the following ingredients:

  • Benadryl (an antihistamine)
  • Dextromethorphan (the 'DM' in cough syrups)
  • Codeine or hydrocodone (narcotic cough suppressants)

Multi-symptom cold and cough syrups may contain a decongestant, expectorant, or pain and fever reducer. Some cough syrups may also contain alcohol.

Over-the-counter cough medicines and cough syrups include:

  • Robitussin DM
  • Delsym
  • Children's Triaminic 
  • PediaCare Long-Acting Cough

Cough syrups with codeine and hydrocodone are available only by prescription.

Does Cough Syrup Work?

One of the major factors in the debate over the use of cold and cough syrups in children is the evidence—or, more specifically, the lack of evidence—that they work.

While many parents and pediatricians would say that cold and cough syrups are effective when a child is coughing, these reports are anecdotal evidence and not based on scientific research.

As for the evidence that cough medicine doesn't work, one large review of studies published by Cochrane Reviews in 2014 concluded that "There is no good evidence for or against the effectiveness of OTC medicines in acute cough. This should be taken into account when considering prescribing antihistamines and centrally active antitussive agents in children; drugs that are known to have the potential to cause serious harm."

One reason for the debate is that there are many conditions cause kids to cough, including croup (which is often characterized as difficult to control) bronchitis, asthma, allergies, or the common cold.

More research is needed to determine whether these products are, indeed, effective at treating coughing in kids under certain circumstances. Additional studies would also boost efforts to make cough and cold medicines safer for children in general.

Alternatives

Even with the uncertainty and the warnings, many parents continue to use cold and cough syrups. If you would prefer to try other treatments for your child's cough, there are some alternatives you can explore.

Popular alternative remedies for coughing include:

  • Cool air humidifier
  • Drinking extra fluids
  • Rest and decreased activity, especially avoiding physical activity that may make a cough worse
  • Saline nasal drops, with bulb suctioning for newborns and infants
  • Cough drops for children over age 4 or 5 for which they aren't a choking hazard

If your child has a cough and trouble breathing, a non-stop cough, a cough and high fever, or a cough that isn't going away or getting better after five to seven days, call your pediatrician.

Abuse

Drug abuse in goes far beyond "traditional" drugs, such as marijuana, alcohol, ecstasy, cocaine, and heroin.

A common drug of abuse in teens and young adults is dextromethorphan (also called DXM), which is found in cough syrups.

A combination of cold medicine like Coricidin HBP Cough and Cold ("Triple C") can also be abused. In addition to dextromethorphan, Coricidin HBP Cough and Cold contains an antihistamine. Large doses can cause hallucinations and other serious side effects. There have even been reports of deaths from kids abusing DXM and Coricidin.

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Article Sources
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  2. U.S. Food and Drug Administration. FDA Drug Safety Communication: FDA requires labeling changes for prescription opioid cough and cold medicines to limit their use to adults 18 years and older. Updated January 22, 2018.

  3. Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database Syst Rev. 2014;(11):CD001831. doi:10.1002/14651858.CD001831.pub5

  4. U.S. Food and Drug Administration. When to Give Kids Medicine for Coughs and Colds. Updated July 18, 2017.

  5. National Institute on Drug Abuse. Hallucinogens and Dissociative Drugs. Updated February 2015.