Currently, in the United States alone, there are about 800 non-prescription, over-the-counter (OTC) cold and cough medicines available for young children. OTC cough and cold medications have long been parents’ go-to solution for treating children with cold and flu-like symptoms. But research shows that common pediatric cold and cough products don’t alleviate children’s symptoms, and in some cases these remedies can actually be deadly if misused.
Such products typically contain one or more of the following:
- Decongestants or nasal decongestants such as pseudoephedrine (relieves stuffy nose)
- Expectorants (loosens mucus)
- Antihistamines (eases sneezing and runny nose)
- Antitussives or cough suppressants, such as dextromethorphan (quiets cough)
- Analgesics (relieves pain) and anti-pyretics (reduces fever), such as acetaminophen and ibuprofen
Many OTC cough and cold medications contain more than one of these ingredients. While the benefits these products advertise may seem helpful for a child who is sick, they may not be as effective as you might hope. For example, at least one study has shown honey to be a more effective cough suppressant than cough syrup.
The dangers of cough & cold medications for children
The Food and Drug Administration (FDA) first endorsed the use of pediatric OTC cold and cough medicines in 1976, despite a lack of testing in children. Moreover, no guidelines were issued for use of these medicines in children under 2 years of age. This lack of clarity remained in place for more than three decades until the FDA revisited the issue after several studies called into question the safety of treating children with OTC cough and cold medications.
In 2007, the Centers for Disease Control and Prevention (CDC) examined cough and cold medications commonly used to relieve symptoms of upper respiratory tract infection in children and found that between 2004 and 2005, an estimated 1,519 children under the age of 2 were treated in U.S. emergency rooms for adverse health problems associated with these medications, and approximately 7,000 children under the age of 12 were seen in U.S. emergency rooms for problems related to product use. (Some experts believe that the incidence of complications is underreported given that OTC cough and cold medicines are frequently found in toxicology screens when young children are admitted to the hospital for apparent life-threatening events.)
The CDC report also identified and investigated the 2005 deaths of three infants under 6 months of age. In all three cases, medical examiners determined the underlying cause of death was an unintentional overdose of cough and cold medicines.
The AAP urges parents not to give over-the-counter cough and cold medicines to children under age 4 and to only give such medicines to children ages 4 to 6 under a physician's guidance. For children 6 and older, directions on the label may be followed--but even then the AAP endorses "home remedies" over cough medicine.
Safest ways to administer cough medicine & alternative treatment options
Some OTC pediatric drug manufacturers have voluntarily added warnings to their labels, advising parents not to give their products to children under the age of 6—in line with the AAP’s recommendations. Others have stuck with the federally mandated warning of under age 4.
The Consumer Healthcare Products Association (CHPA) advises parents who decide to use pediatric OTC cough and cold medications to use and administer the medications with caution.
The following steps may help reduce a child's risk of adverse reaction from OTC cough and cold medications:
- Parents should read labels carefully, particularly the “active ingredients” section.
- Avoid giving your child two different medications with the same active ingredient(s).
- Choose a medication that is appropriate for the child’s symptoms. Don’t use a multi-symptom medication if the child has only one troubling symptom.
- Give the medication only for the recommended amount of time.
- Give the right amount of medication at the right time. Check with your child’s health care provider to confirm the correct dose.
- Measure the amount exactly using the device that comes with the medication or one that is designed to measure medication. Avoid guessing or estimating the amount of medication, and do not use a kitchen teaspoon.
- Avoid giving children adult-strength medications (even in a lower dose).
- Never treat children with viral infections such as cold, flu, or chicken pox with products containing aspirin due to the risk of Reye’s syndrome.
- Choose OTC cough and cold medicines with childproof safety caps, when available, and store the medicines out of reach of children.
- Avoid using medicines that sedate children or help them sleep.
- Call your physician, pharmacist, or other health care professional with any questions about using OTC cold and cough medications.
- Be sure to inform your child’s pediatrician of all the OTC products, prescription medications, and other dietary supplements your child is taking in order to avoid harmful interactions or overdose.
Given that the risks associated with pediatric OTC cold and cough medications outweigh their intended benefits, a growing number of parents are deciding not to give them to their young children. If you are among those parents, rest assured, most colds resolve on their own within 7–10 days. In the meantime, there are other strategies parents can use to make their child feel more comfortable including.
Ways to treat coughs and colds without medication:
- Offer plenty of clear fluids (including breast milk) to help loosen mucus and keep children hydrated.
- Use saline nasal drops and a nasal aspirator in babies over the age of 12 weeks and young children to remove mucus.
- Use a cool-mist humidifier to moisten the air and ease breathing. (Be sure to clean the humidifier according to the manufacturer’s instructions.)
- Offer an age-appropriate amount of acetaminophen or ibuprofen in a child over the age of 2 with a fever. (For children under the age of 2 years, the dose varies with weight, not age, so it is best to check with your child’s health care provider.)
- Encourage rest.
- Consult a pediatrician if symptoms persist for more than two weeks, worsen, or if new symptoms appear.