Cough medicines shouldn’t be used in small children

It’s once more cold season, bringing up the question parents commonly face. Should they buy one of those rows and rows of cough, sneeze, and runny nose medicines one finds in every drug store and supermarket?

In a nushell, no — none of the preparations sold over-the-counter to treat upper respiratory infections in children work, and all could be dangerous. That’s the conclusion of a report some years ago by the Food and Drug Administration, one still worth reading.

There is a huge market for these products. Ninety-five million packages of them are sold each year, and drug companies spend millions of dollars marketing them in various ways. The implication of the advertising is that these preparations (most are mixtures of several things) are safe.

In fact, they are not. Poison control centers receive thousands of calls about them every year, and The Centers for Disease Control found that many are seen in emergency departments owing to their side-effects. The FDA even found 123 deaths linked to their use. Possible side-effects can include hallucinations, dangerous over-sedation, and serious heart rhythm disturbances. Over the years I myself have cared for several children in the PICU who had serious side-effects from them.

The problem isn’t just over-dosing errors. The problem is we don’t know the correct dose for children, and estimating how much to give from adult doses is misleading and dangerous. The fundamental problem, though, is that they just don’t work. In fact, a total of six carefully randomized studies testing these agents in children under twelve all showed they worked no better than placebo — in other words, a sugar pill worked just as well. So using them puts a child at some risk with no benefit.

The Food and Drug Administration has issued a public health advisory that they not be used at all in children less then two years of age. They left use in children older than two alone, but I wouldn’t use them for those children, either. They don’t help, and may harm.

If you have questions about cold preparations, by all means talk to your child’s doctor about it. But the growing consensus among physicians is simple — don’t use them in small children.

So what can you use for a child with a bad cough? Some recent research, a good quality study, suggests that Grandma’s old folk remedy of honey actually helps. It not only can sooth the cough, but may have a specific cough-suppressant effect.

Another thing to keep in mind is that persistent cough may actually represent a variant of bronchospasm or wheezing, particularly if your child has had wheezing troubles in the past. So it’s worth checking with your doctor if your child has a persistent cough because anti-wheezing medications, such as albuterol, can help that situation.

Christopher Johnson is a pediatric intensive care physician and author of Your Critically Ill Child: Life and Death Choices Parents Must FaceHow to Talk to Your Child’s Doctor: A Handbook for Parents, and How Your Child Heals: An Inside Look At Common Childhood Ailments.  He blogs at his self-titled site, Christopher Johnson, MD.

Comments are moderated before they are published. Please read the comment policy.

  • FLMD

    It is a societal problem, everyone wants the easy fix whether it be for a cold, losing weight, pain, etc… Cough especially is a problem for parents because it lingers for weeks after all other symptoms of the cold have subsided. I always tell parents that nothing is going to fix the cough other than time, and I do bring up the honey as a natural remedy.
    As for side effects, I just discharged a patient this past week with hallucinations (and cough) which I very strongly suspect are due to the multiple cough medicines mother was giving.

  • Ron Smith

    Hi, Christopher.

    I have to respectfully disagree within the following context.

    I remember when Laura, my youngest daughter, was suffering prolonged seizures resulting from late complications of fetal isotretinoin embryopathy prior to her death in 2012, the dose of phenobarb, just one of her many meds, was just at and slightly above the upper therapeutic level.

    My wife who is also an LPN, commented one day after some internet research on phenobarbital, that she was shocked. She asked me did I know that this drug was a poison.

    I explained to her that ALL medicines are actually poisons at their essence, and that when we prescribe drugs, it is in hopes that the good outweighs the bad. And that is where the art of medicine blends with the science.

    Laura’s need for the medications at that level were necessary because without them she would seizure continuously for three hours, even when we used other rescue anti seizure medications. Heck, she required four diastats one time to get them stopped.

    To make a blanket statement, implied or overt, then that all use of cold medications would lead one to think that there are not cases where they should be used.

    Your perspective in the PICU is certainly one perspective and I appreciate that. But having done NICU as a primary care for 6 1/2 years as a private solo Pediatrician now for thirty years, I have developed an appreciation for how many things we think are absolutes, are really greys.

    When I stated *most* medications had no clear FDA guidance on dosing. Heck, the dose of amoxil was 20 to 40 mg/kg/day tid then. I remember Dr. Yamauchi, one of my Pedi ID profs, telling me even then that we needed to be using 100mg/kg/day long before there were any papers to support that.

    Pediatrics has a long history of having to step closer to the edge because drug companies often did not do the research or testing to show efficacy and safety. I dare say this was the norm. Look at the first successful open heart surgery for Tetralogy of Fallot which was done on a child! That was unproven until…it was proven.

    As to antihistamines, i.e. cough and cold medicines, I have always found that there has been a lack of understanding and appreciation for the different classes and how to appropriate use them.

    As to the FDA, I will have to mention that Bromfed is an approved cold medicine, just so no one thinks there is something amiss if you decide to use them appropriately. As to the OTC meds, the thing that I saw some parents doing was essentially using the same class of medicine, but a different brand, thinking it was a different drug.

    But there is no difference in the way we use Benadryl when I compare what is recommended by my after-hours advice line that I pay for. The dosage recommended is more than I personally like with the resultant side effects there. I didn’t hear you discussed diphenhydramine specifically, but I wonder what you have seen there?

    At any rate, I do use these meds within the context of need and appropriateness based on years of experience with them.

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

  • querywoman

    I took aspirin and cough syrup all the time when I was a kid, and I’ve made it to the late 50s. Plus, my mother was a heavy smoker.
    Maybe all those OTC meds have affected my brain and fingers and caused me to type words some doctors just hate to read.
    Why is it doctors don’t like to give medicines for anything with symptoms anymore while freely dishing out the blood pressure pills and statins?

  • querywoman

    I keep seeing a topic on the net that somewhere, a child is on life support after a tonsillectomy!
    Should we stop doing tonsillectomies? I had one inflicted on me when I was a helpless child.
    I’m all for giving honey, but that’s a sweet! Isn’t that medical heresy?

Most Popular