Over the counter (OTC) cough and cold medications do very little for cough in infants and young children. There is a pile of research that supports this. Parents often agree after they try these tinctures. Because of the lack of effectiveness and concern for side effects (or worse: over-dose), makers of OTC cough and cold medications voluntarily took them off the market in 2007. This was an incredible step in protecting children. In getting rid of unnecessary (and ineffective) medication marketed for young children, we’ve improved pediatric care in this country. Today, some data backs this up.
We worry about babies and young children taking OTC medications, as many of the OTC cough medications marketed for young children are mixtures of more than 1 medication. Instead of a bottle containing just an anti-tussive (anti-cough), many of the products have 3 or more ingredients (Tylenol or Benadryl, with an anti-tussive or a decongestant). Often babies who received the combination medications also received the other medications alone (Tylenol, for example) which, in far too many instances, resulted in an overdose, but rarely in death. Fortunately, this is less likely to happen now as these products are no longer available.
Many new parents wander the drug store aisles looking for medications to help with cold symptom relief for their infants and young children. And often, many of us are confused and frustrated by the lack of options for intervention. When our children are sick and miserable (& not sleeping), we feel equally as bad. Pediatricians recommend honey, humidifiers, rest, nasal suctioning, upright positioning, Vaporub (this is new), and time for young babies and children. But often parents still feel frustrated; we all really like to intervene–it makes us feel useful and nurturing. But there is great news today confirming that the lack of these products on the shelf is keeping our kids healthier.
A study published today finds that since the withdrawal of these medications, there has been a dramatic reduction of ER visits due to side effects from OTC cough and cold medications.
This is good news. And like most things in life, the study illuminates some bad news, too.
The Good Side To The Results:
- Researchers tracked the number of ER visits for 14 months before OTC cough medications were taken off the market and for the 14 months thereafter.
- For children under age 2 years, the estimated ER visits for adverse events (side effects) were less than 1/2 what they had been before the medications were taken off the market.
The Not So Good Side To The Results:
- Total visits for medication side effects for all children less than 12 years of age remained the same. For all comers, infants and school age children, the same number ended up in the ER in both periods of time.
- 2/3 of all ER visits for side effects from medications were a result of unsupervised ingestions (children finding and taking the medications without parental help or supervision).
- All of the medication errors involved in children under age 2 were a result of excess dosing of liquid medication.
So what we do now? Gotta improve this even more.
Mama Doc’s Tips for Maintaining Safety and Wellness During Cough and Cold Season:
- For infants and young children less than 6 years of age, I don’t recommend using any OTC cough and cold medications. Talk with your pediatrician if you’re concerned about your child’s cough, fever, or breathing pattern.
- Learn and review how to dose liquid medications in children. Although it seems simple, many of us need help learning how to measure a cc, a mL, and/or a teaspoon. Here’s my pop-quiz where you can test your skills of measuring liquid medications for kids. Answer key and video reviewing measuring liquid medications (in the context of Vitamin D), too.
- Don’t ever use a kitchen spoon to dose medications. Use the cap that comes with the medication or a syringe from the pharmacy. If you lose the syringe, stop by your local pharmacy for a replacement.
- This data shows us that the majority of children over age 2 with overdoses to OTC cough meds get into medications when parents are away. This is a reminder that judgment lags behind curiosity in young and older children alike.
- Never refer to medication as candy.
- A recent report found that for accidental ingestion of drugs by young children (under age 5), 2/5 of the children were age 2. Toddlers are curious! Be extra careful with toddlers in your home.
- Safety proofing extends past the door-locks and latches you have on the cupboards. We need medications, cleaning chemicals, and toxins locked in cabinets that are up and out of reach.
- When you’re baby-proofing, I always say, “Channel your inner baby.” Get on all fours, move around the house like an infant would, and look for anything a child can get into. You’ll be surprised what you find.
- Remember to create extra barriers of protection around times of transition (ie moves, guests in the house (particularly older relatives), grocery bags on the floor, etc). Holidays, moving homes, travel and new visitors are times when ingestions may be more likely.
Thanks for the medication safety update. One of the scariest moments of my momhood so far was when Will got ahold of a pill that had dropped out of my mother-in-law’s purse (she was carrying some dog pills in a plastic baggie when she came to visit). He was about 13 months old and I had no idea what the pill in his hand was. . . or if he’d ingested any. Fortunately, a quick call to poison control and a google search to identify the pill, quickly assured us that he’d be okay. But my heart was pounding! So the last point about visitors who aren’t used to “childproofing” hit close to home. Reminding others to take safety precautions around your children is important.
Trinity McDermott says
Regarding cough and snotty noses, do you feel it’s safe to use Robotussin DM in young children (2 years – 5 years)? In addition to the things you’ve mentioned (humidifier, which runs all winter long, honey before bed, nasal suction…….I’m only medicating prior to bedtime (2.5 mL for each child before bedtime). THis includes an expectorant and anti cough. It’s because the other items are only working ‘so well’ and when they’re sick with these symptoms, they don’t sleep well. They wont maintain an upright sleeping position. We see Dr. Shifrin in Bellevue, who’s fabulous but I’m interested in following your blog and would love to hear about your specific direction on these otc meds as I wasn’t sure it was covered in the above discussion specifically. I err on the ‘don’t medicate’ side typically, but when it doesn’t do the job and they’re not sleeping or it seems fairly chronic, what’s a mom to do? Our older son takes a heart medication twice daily, so we’re whizzes at calculating mL vs mg vs teaspoons, however, I always check and double check myself (write the dose on the bottle for each child based on weight). So fortunately I passed your pop quiz. Thank you for posting that because I think the teaspoon VS mL is a problem for SO many since the syringes are given out in mL and the otc drugs are often listed in teaspoons (who can get their kids to take something effectively from a spoon?).
Wendy Sue Swanson, MD says
I don’t recommend OTC cough and cold meds for any child under age 6. There is no science or evidence to prove they work in these children. So why take the risk of side effects with no proven benefit?
Consider Vapo Rub if you want to intervene (my post on the latest data), in children over age 2 if you want to use an OTC med. Otherwise, use humidification, upright positioning during sleep, offering good hydration, and time…
And talk with your fabulous pediatrician! Lucky you!