• Mandi Franklin, CPNP

Why I Don’t Recommend Cough and Cold Medication


Many times throughout the workday I get asked the question, “What cough or cold medication do you suggest for my child?”

My answer always is: NONE!

As a parent, you hate seeing your child sick and you’ll do just about anything to make them feel better.

I know, I get it, you want something to help your child with his or her sneezing, coughing, boogers, and crankiness. Especially because children are not the best at personal hygiene when it comes to covering their sneeze or keeping their hands away from their snotty noses.

Believe it or not, their amazing little bodies are EXCELLENT at fighting off common colds all on their own.

Tell me more….

Interestingly, when the FDA approved these medications for kids in the 1970s there were NO studies completed in order to establish safe dosing. Zilch. Nada.

It wasn’t until 2007 when the FDA began looking at these over-the-counter products again due to numerous reports of adverse effects and pediatric deaths.

In 2008, the FDA recommended that over-the-counter cough and cold medications not be given to children under the age of two due to potentially life-threatening side effects. At that time, the FDA also made a statement that cough and cold medications are not a treatment of illness for older children, but just used for symptom relief.

Duh. This had me scratching my head for a number of reasons. Firstly- please note that these medications cannot and will not TREAT your child’s cold. Ever. They may mask symptoms, but will not treat! Secondly- if there are life-threatening side effects for those under 2, you will most definitely not find me suggesting it for your 3-year-old, 4-year-old, 5-year-old, etc. etc. etc. etc.

There have been multiple studies over the years evaluating the efficacy of cough and cold medications for children. All of them show that there is little to no benefit when these are given.

“A Cochrane review of the use of cough medications for acute cough in children found a lack of evidence for the use of OTC cough medications in children, including antitussives, expectorants, and antihistamines.”

What this all means is that if you gave your child a popsicle instead, it just might have the same effect as the above listed medications, except without potentially harmful side effects. (Hint: go for the popsicle!)


Are there risks? (Heck yeah there are!)

These products can be more harmful, than helpful. I tell families and caregivers all of the time, just because it is sold over-the-counter, does not mean it is safe! Take note of the recent recall I posted about. Risks associated with over-the-counter cough and cold medication include:

  • Multiple caregivers involved in a child’s care leading to double dosing

  • Inadequate dosing instruments. Most medications come with a syringe or cup, however many times people resort to kitchen spoons. Never ever use a kitchen spoon to administer medications. Kitchen spoons are actually all different shapes and sizes and should not be used for precise measurement or dosing medications

  • Poor dosing guidance for your child’s age. Many medications are not approved for children. I touch on this in more detail below. Again, just because it is over-the-counter, it does not mean it is safe!

  • Multiple active ingredients and mixing medications, which can lead to toxicity and death

Still don’t believe me? Here are just a few examples that might change your mind:

  • In 2005, the Montgomery County Coroner’s Office in Ohio reported 10 infant deaths in only an 8-month timespan with toxicology findings showing the presence of over-the-counter cold medication

  • In 2006, unexpected infant deaths were reviewed in the state of Arizona. It was found that “ten unexpected infant deaths that were associated with cold-medication use were identified. The infants ranged in age from 17 days to 10 months. Postmortem toxicology testing found evidence of recent administration of pseudoephedrine, antihistamine, dextromethorphan, and/or other cold-medication ingredients in these infants.”

  • Although widely available in all local pharmacies, Dextromethorphan has quite a lengthy list of adverse effects such as anaphylaxis, dystonia, dependence, psychosis, hallucinations, megaloblastic anemia, and even death

  • In a partially double-blind randomized study, parents were to rate which treatment worked best: honey, honey-flavored dextromethorphan, or no treatment at all for nighttime cough and upper respiratory infection symptoms in kids 2-18 years of age. Parents rated honey as the preferred treatment for symptom relief.

  • Over-the-counter cough and cold medications were responsible for 7091 ER visits in 2004-2005 in kids under the age of 12

So… What do I recommend for the common cold?

  • Fluids, fluids, and more fluids- hydration is key!

  • Honey (over the age of 1). Do not offer honey to your child under the age of 1 due to the risk of contracting botulism!

  • Cool mist humidifier

  • Saline nasal spray or drops

  • Acetaminophen or Ibuprofen for any discomfort (call your provider for appropriate dosing instructions)

  • Time- did you know that on average colds can last 10-14 days?

  • Lots of hugs and affection!

When things are worsening, not improving, or if you have concerns, please call your child’s physician, NP, or PA in order to be evaluated.

Until next time,

Mandi

Resources:

https://www.jpedhc.org/article/S0891-5245(07)00467-1/pdf

https://www.poison.org/articles/2008-dec/cold-medicine-dosing-changes-for-kids

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461939/

https://pediatrics.aappublications.org/content/108/3/e52.full

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776795/

https://pubmed.ncbi.nlm.nih.gov/18676517/

https://jamanetwork.com/journals/jamapediatrics/fullarticle/571638

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