The Danger of Cough & Cold Products for Infants & Small Children – Mark Cheong

Source: http://parenthots.com/features/Protect-and-prevent-kids-from-cold-and-flu.aspx

Ask any parent and they will tell you that there’s not much worse than a small child having the flu. A blocked nose invariably makes the child irritable as it affects their sleep and their ability to breathe with ease. As a result, it is no surprise that weary parents who have been kept awake for one too many nights due to an ill child would be eager to seek medication for to help their child breathe and sleep easier.

Although this information is not new, parents are often unaware that most health authorities worldwide have issued strict warnings regarding the use of cough and cold products for children under the age of 2 without medical supervision. Since 2008, drug manufacturers and health authorities have worked to alert prescribers and parents that cough and cold products are contraindicated (should not be used) for children under the age of 2. Many of these cough and cold remedies can be bought Over-The-Counter (OTC) which makes it more important that parents are informed of the danger that these products can pose to their young children.

These cough and cold products include those that contain the decongestants ephedrine, pseudoephedrine, or phenylephrine, the sedating antihistamines diphenhydramine, brompheniramine, promethazine or chlorpheniramine, and the expectorants (cough medicine) guaifenesin and ipecacuanha. The class of products that are of greatest concern are the sedating antihistamines (a.k.a first generation antihistamines).

So why have these warnings been issued?

The main cause of concern in the United States has been the issue of misuse, medication error, overdoses, and inappropriate use of multiple products. More alarmingly however, there have been a number of reports both overseas and locally of infants and children below the age of 2 suffering from severe side effects and even death as a result of being given these cough and cold products.

Post marketing surveillance or medication use reviews and research have also indicated that there is a lack of evidence of effectiveness with regards to the use of cough and cold products in children below the age of 2. When the risks of adverse events and side effects are factored in, there does not appear to be any good justification for the use of these products in this age group.

Source: http://www.theguardian.com/lifeandstyle/2011/dec/19/should-i-use-cough-syrup

What are the most common side effects that can be caused by these medicines?

The sedating antihistamines have the ability to readily cross into the brain, resulting in many side effects as opposed to the non-sedating antihistamines (a.k.a second generation antihistamines) which cross into the brain at much lower concentrations and tend to exert their action on targets outside the brain. Nevertheless, the use of non-sedating antihistamines (e.g. cetirizine, loratidine) is still discouraged for children below the age of 2.

With sedating antihistamines, the most common adverse effects are sedation, dizziness and incoordination. Tremors, hallucinations and convulsions (seizures) may also occur. Excessive doses in children have led to respiratory depression, coma and death. The non-sedating antihistamines can often cause somnolence (drowsiness), increased heart rate and headaches.

So what can a parent do if their child is too young for these products?

Here are some recommendations:

1. A cool mist humidifier can help nasal passages shrink and allow the child to breathe easier 
2. Saline nose drops or spray keep nasal passages moist and helps avoid stuffiness
3. Nasal suctioning with a bulb syringe either with or without saline nose drops, works especially well for infants less than a year old. 

What if my child is slightly older than 2 years of age and has been prescribed a cough and cold product?

In addition to being watchful, parents should:

1. Always follow the instructions on the medicine label and read any information leaflets provided
2. Never exceed the recommended dose, frequency of dosing or duration of use, even if the child does not appear to improve or symptoms are not relieved with the current dose
3. Always use a measuring spoon or oral syringe supplied with the product or given by the pharmacy to measure the dose. Never use ordinary kitchen spoons and do not use common estimates like “one teaspoon is the same as 5mls”
4. Never mix and match more than one cough and cold products or medicines at the same time unless your pharmacist or doctor has instructed you to do so
5. Always seek advice from your pharmacist or doctor if you have any doubts whatsoever

Mr. Mark Chong is a pharmacist currently working in Kuala Lumpur. His research interests lie in the implementation strategies of public health measures. Find out more about him at The Team page.

References:

• An Important FDA Reminder for Parents: Do Not Give Infants Cough and Cold Products Designed for Older Children (www.fda.gov)
• TGA Announcement: Cough and cold medicines in children (www.tga.gov.au)
• Sedating Antihistamines in Children – Not a Good Choice. J PRIM HEALTH CARE 2013;5(2):162–163.
• Children and Sedating Antihistamines. New Zealand Medicines and Medical Devices Safety Authority (www.medsafe.govt.nz)

[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.] 

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