As winter approaches, many parents will be preparing for cold and flu season. Young children typically get at least six colds a year.
In previous generations, parents might have taken cough syrup to relieve a dry or wet cough.
But we now know that cough syrups are not very effective in treating children’s coughs.
And amid mounting evidence of poisoning harm and deaths, many countries, including Australia, have restricted cough medicines so they can’t be given to children under the age of six.
What’s in cough medicine?
The active ingredients in cough syrups vary according to their claimed benefit. They may contain cough suppressants (dampening the body’s cough reflex), expectorants, and mucolytics (both of which help clear phlegm).
Other medicines marketed for cold and flu often contain decongestants (to relieve a stuffy nose) and sedating antihistamines to ease sneezing, stop a runny nose, and help you sleep.
The riskiest drugs are those with a sedative action, such as sedating antihistamines or opioid-based cough suppressants. While sedation may be a desired effect for parents with an insomniac child, young children are particularly at risk of serious harm or death. Sedatives can also cause agitation and hyperactivity.
While cough syrups that don’t contain sedatives are probably safer, there are very few studies on the safety and effectiveness of these products in children. Adverse events including agitation and psychosis have been reported, especially with excessive use.
Overuse can result from parents misreading the label, intentionally using more in the hope it will work better, unintentional extra doses, and the use of inaccurate measuring devices such as household spoons.
How are cough syrups restricted?
Children under two years of age are most at risk of a fatal overdose from cough syrups. But the Australian regulator advises against the use of cough syrups by anyone under the age of six.
Therefore, there are no dosing instructions for children under six on the labels of these products.
Cough syrups are still available for older children and adults. Pharmacists are likely to ask the age of the person who will be taking it and provide guidance on proper dosage and use.
Our research, published today in the Medical Journal of Australiashows that limiting the use of cough and cold medications in children results in a significant and sustained decrease in poisonings.
Our study looked at dosing errors, adverse events at correct doses, and accidental “exploratory ingestions,” such as when a child helps himself to the medicine cabinet.
The government mandated labeling changes in 2012 and 2020 for these products.
In 2012, labels for cough-and-cold medicated products could no longer list dosing instructions for children under six and had to carry additional warnings.
In 2020, warnings were placed on sedating antihistamines saying they should not be used in children under two years of age to Anyone reason (including allergy and hay fever).
This has resulted in a halving of the rate of calls to poison control centers and a halving of the rate of hospitalizations. Despite this, hundreds of calls to Australian poison centers are still made each year regarding these products in young children.
When is it okay to use cough syrups?
The damage has mostly been documented in younger children. This is likely due to their smaller size, which means it takes less medicine to cause harm, and also their susceptibility to sedative effects due to their developing brains.
Cough syrups can be used in children aged six to 11, however caution is needed. These products should only be given in consultation with a doctor, pharmacist or nurse.
Some herbal products are available and marketed for children, such as Hedera helix (ivy leaf extract). Unfortunately, there is no convincing evidence that these drugs significantly improve cough symptoms. But the risk of poisoning is low.
Even simple syrups that contain no drugs can be effective: Up to 85 percent of the effectiveness of cough medicines has been attributed to the placebo effect.
This could be due to the syrups that coat the throat and dull that irritating tickling sensation.
So what can I do for my child?
The best thing you can do for your child is give them rest and reassurance.
Antibiotics will only be needed if a doctor diagnoses them with acute bacterial pneumonia or a chronic cough due to a bacterial infection, such as protracted bacterial bronchitis, whooping cough, or lung abscess.
Acetaminophen or ibuprofen can be used if they have fever, aches and pains along with cough. Check the correct dosage on the package for your child’s weight and age.
If your child is over 12 months old and has a wet cough (producing phlegm in the throat), consider giving him honey. There is growing evidence that honey can reduce mucus production and, therefore, the amount you cough.
Rose Cairns, Lecturer in Pharmacy, University of Sydney and Nial Wheate, Associate Professor, Sydney Pharmacy School, University of Sydney.
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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