The Risks of Pediatric Cough Medicine

Mother giving daughter medicine

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Choosing the right pediatric cough medicine can be difficult for parents since a cough in kids is one of the more frustrating symptoms to treat.

Not only can coughing keep your kids up all night, but it can also get them sent home from school if the coughing is very distracting to other students in the class. But parents often run into trouble when trying to find a cough syrup to quiet their child's cough.

Cold and Cough Syrup Warnings

Warnings on cold and cough syrups say the products shouldn't be given to children under age four. Parents should not give give small children or infants the pediatric cold and cough products that are designed for older children. Children under two years old should never be given cold and cough products with decongestants and antihistamines, without first seeking medical advice.

Cough Syrups

Medicines that are supposed to help quiet coughs (antitussive medicines) usually include one or more of these ingredients, including:

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

Many cough syrups also contain alcohol.

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

Commonly used 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.

Do Cough Syrups Work?

One of the biggest factors in the debate over the use of cold and cough syrups in children is the evidence, or lack of evidence, that they actually work.

Although many parents and pediatricians are often sure that cold and cough syrups do indeed work when a child is coughing, that is usually based on anecdotal evidence and not based on scientific research.

But what about all of the evidence that states that cough medicines don't work? Unfortunately, most of it isn't that good. One large review of these studies published by Cochrane Reviews in 2014 concluded:

"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 problem is that kids cough for a lot of different reasons. For example, they might have a cough when they have croup, which is often characterized as difficult to control, bronchitis, asthma, allergies or the common cold.

Since parents still seem to be using these cold and cough syrups, even with the warnings, hopefully, more research can be done to see if they are helpful for some children. Then, more work can be done to make them safer for all children.

Alternatives

So if your child is coughing and you are supposed to use a cold and cough syrup for your younger child, what are you supposed to do?

Some alternative remedies to using a cough syrup that may be helpful 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

Call your pediatrician 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.

Abuse

Unfortunately, many kids abuse drugs. And these days, it goes far beyond "traditional" drugs, such as marijuana, alcohol, ecstasy, cocaine, and heroin.

Many teens now actually abuse dextromethorphan (also called DXM), which is found in cough syrups. Or they may abuse a combination cold medicine like Coricidin HBP Cough and Cold, which is also known as "Triple C."

In addition to dextromethorphan, Coricidin HBP Cough and Cold also contain an antihistamine. Large doses can cause teens to have 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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  1. U.S. Food and Drug Administration. Use Caution When Giving Cough and Cold Products to Kids. Updated February 8, 2018.

  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.