As winter approaches, many parents will be preparing for cold and flu season. Young children usually catch at least six colds a year.
In previous generations, parents could use cough syrup to relieve a dry or chest cough.
But we now know that cough syrups are not very effective in treating coughs in children.
And amid growing evidence of the harms from poisonings and deaths, many countries, including Australia, have restricted cough medicines so they cannot be given to children under the age of six.
What’s in cough medicine?
The active ingredients in cough syrups vary depending on their claimed benefit. They may contain antitussives (reducing the body’s cough reflex), expectorants and mucolytics (both of which help clear phlegm).
Other marketed cold and flu medications often contain decongestants (to relieve a stuffy nose) and sedating antihistamines to relieve sneezing, stop a runny nose, and promote sleep.
The most risky drugs are those that have a sedative action, such as sedating antihistamines or opioid-based cough suppressants. Although sedation may be a desired effect for parents of an insomniac child, young children are particularly at risk of serious injury or death. Sedatives can also cause restlessness and hyperactivity.
Although 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, particularly with overuse.
Overuse can result from parental misreading of the label, intentional use more in the hope that it will work better, inadvertent extra doses, and use of inaccurate measuring devices such as than domestic spoons.
How are cough syrups restricted?
Young children under the age of two are most at risk of a fatal overdose of cough syrups. But Australia’s medicines regulator advises against the use of cough syrups for anyone under the age of six.
As such, there are no dosage 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 taking it and provide advice on dosage and proper use.
Our research, published today in the Australian Medical Journalshows that restricting the use of cough and cold medicines in children results in a significant and lasting decrease in poisonings.
Our study looked at dosing errors, adverse events at correct doses, and accidental “exploratory ingestions”, such as when a toddler helps himself from the medicine cabinet.
The government imposed labeling changes in 2012 and 2020 for these products.
In 2012, labels for cough-and-cold medications could no longer show dosage instructions for children under six and had to carry additional warnings.
In 2020, warnings were put on sedating antihistamines saying they should not be used in children under two for any reason (including allergies and hay fever).
This resulted in a halving of the rate of calls to the poison control center and a halving of the rate of hospitalizations. Despite this, hundreds of calls are still made each year to Australian poison centers regarding these products in young children.
When is it okay to use cough syrups?
Harms have mostly been documented in young children. This is likely due to their small size, which means less medication is needed to cause damage, as well as their susceptibility to sedative effects due to their developing brains.
Cough syrups can be used in children aged 6 to 11, but caution is advised. These products should only be administered in consultation with a physician, pharmacist or nurse practitioner.
Some herbal products are available and marketed for children, such as ivy helix (ivy leaf extract). Unfortunately, there is no convincing evidence that these medications significantly improve cough symptoms. But the risk of poisoning is low.
Simple drug-free syrups can also be effective: up to 85% of the effectiveness of cough medicines is attributed to the “placebo effect”.
This could be due to the syrups coating the throat and alleviating that irritating tickling sensation.
So what can I do for my child?
The best thing you can do for your child is to give him 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 prolonged bacterial bronchitis, whooping cough, or lung abscess.
Paracetamol or ibuprofen can be used if they have fever, aches and pains in addition to their cough. Check the correct dosage on the package based on 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 of coughing.
Rose Cairns, Lecturer in Pharmacy, University of Sydney and Nial Whate, Associate Professor at Sydney Pharmacy School, University of Sydney.
This article is republished from The Conversation under a Creative Commons license. Read the original article.