Cough and cold medicines are commonly used, and are potentially dangerous. According to the Food and Drug Administration (FDA) website, these products may contain several ingredients, including 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 (non-active medications) 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, their potentially dangerous side effects may outweigh any benefits.

As stated in a previous article in Pediatrics for Parents, approximately 7,000 children are treated in emergency departments every year due to secondary side effects from cold or cough medicines. Some ingredients of these medicines, 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
•    Receiving multiple cough or cold medications that contain the same ingredient

The FDA recommends-even warns on 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 child’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 cold or cough medications inappropriately per dosing recommendation labels despite 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.

It is vital for parents and caregivers to talk with their pediatricians or other health care providers before giving cough or cold medicines. They should also closely follow the directions on the medications’ labels regarding the indications, use and delivery.

It is important that parents and caregivers only use the measuring spoons or cups that come with the medicine. Often, parents may 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.

Also, it is important for parents to be aware that these medications do not quiet cough, do not improve sleep, and are not any better than a placebo for children in the improvement of cough and cold symptoms.

According to 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 12 months. (Honey is not considered safe for children under age 12 months as it may contain bacteria that cause infant botulism.) Using a bulb suction with or without saline (salt water) drops may also help with congestion in children even younger than 12 months.

Often, viruses cause cold and cough symptoms, so symptoms should improve in about 5-7 days without any medications. In all cases, should symptoms persist or worsen, or questions arise, consult your pediatrician or health care provider.

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From issue: 29/01-02