Over-the-Counter Cough Syrups

When children develop a cough, many parents’ first instinct is to find a quick remedy to relieve their discomfort. Over-the-counter (OTC) cough syrups seem like an easy solution, but their use, especially in young children, comes with significant caveats. In recent years, experts have raised concerns over the safety and effectiveness of these medications, particularly in children under six years old.  

Why the Change? Understanding the Need for Updated Recommendations 

OTC cough syrups for children, which often contain ingredients like dextromethorphan (a cough suppressant) and guaifenesin (an expectorant), have long been considered safe and effective. However, recent studies and ongoing concerns about potential risks, including adverse side effects and questionable effectiveness in young children, have led to recent updates in guidelines. 

Key Concerns Prompting Updated Recommendations: 

1. Limited Effectiveness
   Studies indicate that cough syrups often do not provide significant relief for children’s coughs, especially those caused by viral infections. Coughs are usually self-limiting and resolve as the infection clears, so using medication for relief may not be effective. 
2. Risk of Overdose
   Cough syrups often contain multiple active ingredients, increasing the risk of accidental overdose. This is particularly dangerous with young children, who are more sensitive to dosages than adults. Accidental overdose can lead to serious health complications, such as breathing difficulties and even hospitalization in severe cases. 
3. Side Effects
   Common side effects of OTC cough syrups include drowsiness, irritability, upset stomach, and dizziness. In younger children, these side effects can be more pronounced and harder to manage. 
4. Masking Symptoms
   Treating a cough symptomatically with medication may mask underlying symptoms of a more serious condition. For example, persistent coughs may be related to asthma, allergies, or infections that require medical attention. 
5. Dependency and Habit Formation
   Overusing cough syrups can create a habit where both parents and children rely on medication at the first sign of a cough, even when it is unnecessary. This dependency can lead to issues when medical intervention is required, as reliance on OTC medications can delay professional consultation. 

Age-Specific Recommendations: Under 6 and Over 6 Years Old 

For Children Under 6 Years Old 

Most health authorities, including the FDA, strongly advise against the use of OTC cough syrups in children under six. Research has shown that these medications not only lack significant effectiveness in this age group but also carry potential risks. 

Key Reasons for This Recommendation: 

• • Children under six are more vulnerable to side effects and accidental overdose. 

• • The coughs associated with viral infections typically resolve without medication. 

• • Studies have not shown clear benefits of cough syrups for children under six, making the potential risks unjustifiable 

For Children Over 6 Years Old 

For children over six, some OTC cough syrups may be safe to use, but with caution. Parents should follow all label instructions carefully, avoid multi-symptom formulations, and never exceed the recommended dose. Even in this age group, though, cough syrups should be used sparingly.  

Key Considerations for Children Over Six: 

• • Use only age-appropriate formulas labeled specifically for children. 

• • Avoid using cough syrups with multiple active ingredients due to risk of side effects. 

• • Carefully measure doses according to weight and age to avoid accidental overdose. 

Recommendations for Parents: Alternatives to Cough Syrup for Children 

1. Natural Remedies and Hydration
   Encourage plenty of fluids, as staying hydrated helps thin mucus and soothe a sore throat. Warm water with honey and lemon (for children over 1 year) can help ease cough and is a safer alternative to medications. 
2. Use of a Humidifier
   A cool-mist humidifier in the child’s room can add moisture to the air, helping ease cough symptoms and reducing throat irritation, especially at night. 
3. Saline Nose Drops
   If a cough is accompanied by congestion, saline nose drops can help clear nasal passages and relieve postnasal drip, a common cause of coughing. 
4. Honey for Children Over 1 Year
   Honey has natural cough-suppressant properties. A teaspoon of honey before bedtime can soothe the throat and reduce coughing. However, avoid giving honey to children under one year due to the risk of botulism. 
5. Encourage Rest
   Rest helps the immune system fight off infections. Ensure your child is well-rested and avoids activities that can exacerbate their cough. 
6. Cough Drops for Older Children
   For children over six, cough drops can be a safe option to soothe the throat temporarily. Be sure to supervise their use, as younger children could choke on them. 
7. Elevate Head During Sleep
   Elevating your child’s head slightly while sleeping can help reduce nighttime coughs by promoting better airflow. 

When to See a Pediatrician 

It is essential to recognize when a cough may need medical attention. Contact your child’s pediatrician if you observe any of the following: 

• Persistent cough lasting more than a week 

• Cough accompanied by high fever or difficulty breathing 

• Cough that causes your child to vomit repeatedly 

• Wheezing, especially if your child has a history of asthma 

• Any other concerning symptoms like fatigue, loss of appetite, or dehydration 

If your pediatrician’s office is closed, book a telemedicine appointment to contact our Board-certified pediatricians.