On Parenting: Cough Medicine Isn't for Kids

When a child is suffering, it's hard to resist giving a dose. But we should.

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I confess: I drugged my kid. My intentions were good; she had a cough and needed to sleep. Surely a spoonful of cough medicine would be a mercy. My 4-year-old slurped up the grape-flavored syrup and trotted off to bed. Good mommy? Hardly.

I already knew that the cold medicines that crowd pharmacy shelves have never been properly tested to see if they're safe or effective for children. The reason those cheerful packages don't list dosages for children under age 2, but just say "ask a doctor," is that the Food and Drug Administration has never approved a safe amount. No parent is going to dare to call the pediatrician in the middle of the night with a question like that. But the fact is that a bleary bedside calculation, dividing an older child's dose by whatever seems kind of OK, is no way to practice medicine on one's beloved.

When I revealed my transgressions to Ian Paul, a pediatrician who has uncovered the shortcomings of children's cold medicines, he was sympathetic. "It's hard," says Paul, an associate professor of pediatrics and public-health sciences at Penn State University, "because we have such a strong desire to get things to a child who's uncomfortable." He was surprised to learn, back in 1997 when the American Academy of Pediatrics warned parents that two popular over-the-counter cough suppressants, codeine and dextromethorphan, did nothing to relieve coughs in young children, that there was very little research on the subject. Paul decided to do some investigating himself. He tested two of the most widely used kid cold remedies, the antihistamine diphenhydramine (Benadryl) and dextromethorphan, giving them to kids whose ages ranged from 2 to 18. Not only were the drugs no better than a placebo at relieving symptoms, but neither the child nor the parents got more sleep. (Other research, including reviews by the Cochrane Collaboration, found little evidence that the drugs relieve symptoms in adults, either.)

Despite the hard evidence, I could almost convince myself that the lollipop in a spoon might have a harmless placebo effect were it not for the fact that these nostrums aren't harmless. Earlier this year, the Centers for Disease Control and Prevention reported that 1,519 children under age 2 wound up in emergency rooms in 2004 and 2005 for overdoses and other problems caused by cough and cold medicines. In 2005, three babies died from the drugs. The problem, Paul says, is that it's too easy to administer too much. Parents may give two different remedies, not realizing that both contain the same active ingredient. Or Dad gives a dose, and then Mom does, too. Or the day-care provider medicates a kid who was already given medicine at home. Tiny children are particularly vulnerable, because the margin of error is so much smaller.

The safe options recommended by the CDC, the American Academy of Pediatrics, and the American College of Chest Physicians are pretty basic: a single-ingredient pain reliever, such as ibuprofen or acetaminophen; nasal saline nose drops for stuffiness; and a warm steam bath to loosen phlegm. Not sexy stuff. But relief may be on the way. Paul is in the midst of researching what can help kids with cough and cold symptoms. Next week, the FDA is calling together an expert panel to debate whether it's time to change our willy-nilly approach to children's cold care. The public-health experts whose petition prompted the hearing asked the FDA to ban use of the drugs in children under age 6. The FDA might not go that far, but the panel may well recommend reining in marketing of over-the-counter remedies and also try to make it clearer to parents that these drugs are no panacea.

I know that I've got to go cold turkey. Goodbye, sweet elixirs. Next time I've got a miserable stuffy-nosed kid on my hands (which will be soon, given that children get six to 10 colds a year), I'll have to grit my teeth and stick with the remedy I know will provide comfort, if not relief—a Mommy snuggle.

Corrected on : Corrected on 10/10/07: An earlier version of this story misstated the name of the American Academy of Pediatrics and said that Ian Paul is testing drugs; he's actually testing other methods of relieving cough and cold symptoms in children.