Cough and cold medicines for kids are likely a waste of your money and an unnecessary risk

A number of people have been emailing me or tweeting me about the use of OTC meds for kids in light of this severe flu epidemic. So let me cut to the chase. Medications for fever work. They work for pain, too. But cough and cold meds? No. From our first book:

As pediatricians, we really wish that we could recommend something to help parents and children feel better.  Unfortunately, over-the-counter cough and cold medicines are not the answer.  First of all, they don’t work. Since 1985, all six randomized, placebo-controlled studies of the use of cough and cold medicines for children under the age of 12 years did not show any difference between taking a cough or cold medicine or taking a placebo or fake medicine.  Expert panels have reviewed these studies and have all agreed that there is no evidence to suggest these medicines work for kids.  The American College of Chest Physicians stated that the scientific literature for over-the-counter cough medicines did not support that cough medicines worked.  A 1997 policy statement from the American Academy of Pediatrics stated that support for the use of cough medicines in children had not been established.  So, neither the medical experts, nor the scientists, nor the chest doctors, nor the pediatricians think that these medicines work.

Even worse than not working, over-the-counter cough and cold medicines have bad side effects and can even kill children.  During the years 2004 to 2005, 1,519 children in the United States under the age of 2 had to go to the emergency room because of a bad reaction or overdose related to cough and cold medications. The bad reactions included serious problems like abnormal heart rhythms, loss of consciousness, and brain damage.  In 2005, three infants under the age of 6 months died because of cough and cold medicines (this was verified as the cause of death by the medical examiners or coroners in each of these instances).  An FDA review found 123 deaths that could be tied to cough and cold medicines used in children under 6 years of age over the past 30 years.

The bottom line is this: if something doesn’t work well and it has the potential to put your child in the hospital or kill them, we don’t think it’s a good idea.

Want some references? Try these:

  1. American Academy of Pediatrics Committee on Drugs. Use of codeine- and dextromethorphan-containing cough remedies in children. Pediatrics 1997 Jun;99(6):918-20.
  2. Bhatt-Mehta V. Over-the-counter cough and cold medicines: should parents be using them for their children? Ann Pharmacother. 2004 Nov;38(11):1964-6.
  3. MMWR Morb Mortal Wkly Rep. 2007 Jan 12;56(1):1-4. Links Infant deaths associated with cough and cold medications–two states, 2005.
  4. Chang AB, Landau LI, Van Asperen PP, et al. Cough in children: definitions and clinical evaluation. Med J Aust. 2006 Apr 17;184(8):398-403.
  5. Chang AB, Peake J, McElrea MS. Anti-histamines for prolonged non-specific cough in children. Cochrane Database Syst Rev. 2008 Apr 16;(2).
  6. Public Health Advisory. Nonprescription Cough and Cold Medicine Use in Children.
  7. Schroeder K, Fahey T. Over-the-counter medications for acute cough in children and adults in ambulatory settings. Cochrane Database Syst Rev. 2004 Oct 18;(4).
  8. Sharfstein JM, North M, Serwint JR.N Engl J Med. 2007 Dec 6;357(23):2321-4. Over the counter but no longer under the radar–pediatric cough and cold medications.

There’s no question that having the flu sucks. Treat a child’s pain and fever. Take care of them. Provide them comfort. But these OTC cough and cold medications probably aren’t the best way to go.


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