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Coughs and Cough Syrup

Cold and Flu Season

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Updated November 30, 2008

A cough is one of the more frustrating symptoms in pediatrics.

Not only can coughing keep your kids up all night, but it can get him sent home from school if the coughing is very distracting to other students in class.

So it would make sense for parents to look for a cough syrup to quiet their child's cough.

Cold and Cough Syrup Warnings

Unfortunately, an FDA public health advisory about children's cold and cough syrups states that "questions have been raised about the safety of these products and whether the benefits justify any potential risks from the use of these products in children, especially in children under 2 years of age."

New warnings on cold and cough syrups now even say that they shouldn't be given to children under age 4.

Even though the FDA reports that most problems with cold and cough syrups occur when "more than the recommended amount is used, if it is given too often, or if more than one cough and cold medicine containing the same active ingredient are being used," since there is little proof that these medicines actually work, experts recommend that parents avoid them.

Cough Syrups

Medicines that are supposed to help quiet coughs (antitussive medicines) usually include one or more these ingredients, including:

  • Benadryl (an antihistamine)
  • dextromethorphan (the 'DM' in cough syrups)
  • codeine or hydrocodone (narcotic cough suppressants)

Many cough syrups also contain alcohol.

Multi-symptom cold and cough syrups may also contain a decongestant, expectorant, and/or pain and fever reducer.

Commonly used cough medicines and cough syrups include:

  • Robitussin DM
  • Delsym
  • Children's Triaminic Thin Strips, Long Acting Cough
  • PediaCare Long Acting Cough

Cough syrups with codeine and hydrocodone are available only by prescription.

Do Cough Syrups Work?

One of the biggest factors in the debate over the use of cold and cough syrups in children is the evidence, or lack of evidence, that they actually work.

Although many parents and pediatricians are often sure that cold and cough syrups do indeed work when a child is coughing, that is usually based on anecdotal evidence and not based on scientific research.

But what about all of the evidence that states that cough medicines don't work? Unfortunately, most of it isn't that good. One large review of these studies from the Cochrane Reviews concluded that "there is no good evidence for or against the effectiveness of OTC medications in acute cough. The results of this review have to be interpreted with caution because the number of studies in each category of cough preparations was small. Many studies were of low quality and very different from each other, making evaluation of overall efficacy difficult."

One problem is that kids cough for a lot of different reasons. For example, they might have a cough when they have croup, which is often characterized as difficult to control, bronchitis, asthma, allergies, or the common cold.

Since parents still seem to be using these cold and cough syrups, even with the warnings, hopefully more research can be done to see if they are helpful in some children, then more work can be done to make them safer for all children.

Alternatives to Cough Syrup

So if your child is coughing and you are supposed to use a cold and cough syrup for your younger child, what are you supposed to do?

Some alternative remedies to using a cough syrup that may be helpful include:

  • cool air humidifier
  • drinking extra fluids
  • rest and decreased activity, especially avoiding physical activity that may make the cough worse
  • saline nasal drops, with bulb suctioning for newborns and infants
  • cough drops for children over age 4 or 5 for which they aren't a choking hazard

Call your pediatrician if your child has a cough and trouble breathing, a non-stop cough, a cough and high fever, or a cough that isn't going away or getting better after 5 to 7 days.

Cough Syrup Abuse

Unfortunately, many kids abuse drugs. And these days, it goes far beyond "traditional" drugs, such as marijuana, alcohol, ecstasy, cocaine, heroin, etc.

Many teens now actually abuse dextromethorphan (also called DXM), which is found in cough syrups. Or they may abuse a combination cold medicine like Coricidin HBP Cough and Cold, which is also known as "triple C." In addition to dextromethorphan, Coricidin HBP Cough and Cold also contains an antihistamine. Large doses can cause teens to have hallucinations and other serious side effects. There have even been reports of deaths from kids abusing DXM and Coricidin.



Sources:

AAP Policy Statement. Use of Codeine- and Dextromethorphan-Containing Cough Remedies in Children. PEDIATRICS Vol. 99 No. 6 June 1997, pp. 918-920. Reaffirmed February 1, 2007.

FDA Public Health Advisory on Nonprescription Cough and Cold Medicine Use in Children. Updated October 10, 2008.

Gadomski A, Horton L The need for rational therapeutics in the use of cough and cold medicine in infants. Pediatrics. 1992; 89:774-776

Over-the-counter medications for acute cough in children and adults in ambulatory settings. Cochrane Database Syst Rev 2004;(4):CD001831

Smith MBH, Feldman W Over-the-counter cold medications. A critical review of clinical trials between 1950 and 1991. JAMA. 1993; 269:2258-2263.

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