Cough

Updated 16 November 2016

Cough mixtures for toddlers and small children

Although there is a lot of caution - and rightly so - around the use and abuse of cough mixtures, there are a limited number of safe options.

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Recent concerns have been raised about the safety of cough and cold medicines when used in children less than 2 years of age.

Some interesting facts:

- on October 2nd 2007 the FDA ruled to discouraged the use of cold and cough mixtures for children younger than 6 years.
- The Consumer Healthcare Products Association (CPHA) , a group that represents the manufacturers of over-the-counter (OTC) cold and cough mixtures, announced that its members would voluntarily revise product labels for use in kids < 4 years of age.
- In the July 2007 South African Medical Journal (SAMJ vol 97 issue 7), an MCC alert was issued for health care professionals for new prescribing information for promethazine.
- The current package inserts for promethazine containing products should be updated to reflect a contraindication to use in children under the age of 2 years because of the risk of fatal respiratory depression in this group.

Many of these patients visit their family doctors who may prescribe antitussives (cough suppresants, expectorants, mucolytics) decongestants, antihistamines, analgesics, sometimes combined with an antibiotic. Tthe Cochrane Collaboration (2008) found no good evidence for or against OTC medicines in treating acute cough. However, excessive mucous build-up may require treatment to prevent other complications. Therefore the use of humidifiers, paracetamol etc encouraged. Despite warning about the use of cough and cold medications in children, 40% of parents have used cough medicines for children younger than two years old. 

The use of cough mixtures in children less than 2 years old

Concerns have been raised about the safety of cough and cold medicines when used in children less than 2 years of age. In the UK, at least five deaths were linked to certain cough and cold medications. These medicines which contains promethazine, a respiratory depressant, are not available over the counter any longer, and are sold under restricted conditions as parents in the UK are being warned about the dangers of giving toddlers potentially fatal overdoses.

In the July 2007 South African Medical Journal (SAMJ vol 97 issue 7), an MCC alert was issued for health care professionals for new prescribing information for promethazine. The current package inserts for promethazine containing products should be updated to reflect a contraindication to use in children under the age of 2 years because of the risk of fatal respiratory depression in this group. Serious life threatening cases of respiratory depression, including fatalities, have been reported with the use of promethezine in children under 2 years of age. 

There are a number of over the counter products that contain promethazine. These include, antihistamines, and combinations of analgesics, antipyretics, and cough and cold preparations. 

However, a number of these medications are still available, even as over the counter medicines. Mandisa Hela, head of the MCC, said at the time that in general many of the products listed, and those with the potentially dangerous ingredients, were not allowed for children under the age of 2. She said that when the decision not to allow their use in the US and UK was announced, many of the manufacturers voluntarily changed the age limit or changed the formulation of the medication.

The need for safe cough medications

Upper respiratory infections, especially viral infections are common in young children as they slowly build up their immunity. Many of these patients visit their family doctors who may prescribe antitussives, decongestants, antihistamines, analgesics, sometimes combined with an antibiotic.

What are the dangers of cough medicine?

Although cough medicine can be bought over the counter, the medicine still carries the risk of potentially fatal side effects. Follow the directions on the syrup's label to minimise the chances of complications when using the drug.

Children

TheBostonChannel.com reports that cough medicine can cause such potentially fatal side effects as unconsciousness and stop breathing in children and toddlers.

Teen abuse

The medicine's OTC accessibility makes it popular for abuse among teens. They chug the syrup for a quick, cheap high from dextromethorphan, one of the medicine's active ingredients.

Drowsiness

Cough syrup usually contains a warning label to not operate machinery or drive a vehicle while using it because drowsiness is a common side effect.

Alcohol

Cough syrup may contain ingredients that will cause a negative reaction to alcoholic drinks. Many syrups also contain alcohol, which can worsen side effects such as sleepiness or dizziness.

Overdose

Depending on how much you ingest, an overdose of cough syrup can cause such complications as blurred vision, hallucinations, nausea, and vomiting, and can lead to comas and death.

Also read:

Is your child’s cough keeping you up at night?

Treating your child’s cough

Winter is on its way, bringing along colds and flu

Image: Boy coughing form Shutterstock

 

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Cough Expert

Professor Keertan Dheda has received several prestigious awards including the 2014 Oppenheimer Award, and has published over 160 peer-reviewed papers and holds 3 patents related to new TB diagnostic or infection control technologies. He serves on the editorial board of the journals PLoS One, the International Journal of Tuberculosis and Lung Disease, American Journal of Respiratory and Critical Medicine, Lancet Respiratory Diseases and Nature Scientific Reports, amongst others. Read his full biography at the University of Cape Town Lung Institute.

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