Why can children have antitussive (cough suppressant) medication?

From the Guidelines

Children should generally not be given adult cough medicines, and for kids under 4, all over-the-counter cough and cold medications should be avoided. The reason for this is that these medications can have serious side effects in young children and have not been proven to be effective in this age group 1.

Safe Options for Managing Coughs in Children

Safe options for managing coughs in children include:

• Honey (for children over 1 year old): 1/2 to 1 teaspoon as needed
• Saline nasal drops and gentle suctioning for infants
• Cool-mist humidifier in the child's room
• Plenty of fluids and rest

According to the most recent and highest quality study, honey may offer more relief for cough symptoms than no treatment, diphenhydramine, or placebo, but it is not better than dextromethorphan 1. However, due to the potential for serious side effects, codeine-containing medications should be avoided in children 1.

Importance of Pediatrician Guidance

For children 4-11, any medication use should be directed by a pediatrician. If a cough persists or is severe, consulting a pediatrician for appropriate treatment tailored to the child's age and condition is crucial. This approach ensures that the treatment is both safe and effective, minimizing the risk of adverse events while addressing the child's specific needs 1.

Considerations for Cough Management

Cough in children should be treated based on etiology, and there is little evidence for using medications for the symptomatic relief of cough 1. Environmental influences and parental expectations should be discussed and managed accordingly, as cough can negatively impact the quality of life of both the child and parents 1.

From the FDA Drug Label

Directions • shake bottle well before use • measure only with dosing cup provided • do not use dosing cup with other products • dose as follows or as directed by doctor adults and children 12 years of age and over 10 mL every 12 hours, not to exceed 20 mL in 24 hours children 6 to under 12 years of age 5 mL every 12 hours, not to exceed 10 mL in 24 hours children 4 to under 6 years of age 2.5 mL every 12 hours, not to exceed 5 mL in 24 hours children under 4 years of age do not use

Children can have antitussive (cough suppressant) medication because the dosing instructions provided on the label specify recommended doses for children of different age groups, including:

• Children 12 years of age and over
• Children 6 to under 12 years of age
• Children 4 to under 6 years of age However, it is contraindicated for children under 4 years of age 2.

From the Research

Antitussive Medication for Children

• Antitussive medications, also known as cough suppressants, can be used in children to relieve cough symptoms 3, 4.
• However, the use of these medications in children is often controversial due to concerns about their efficacy and safety 5, 6, 7.
• The US Food and Drug Administration (FDA) does not recommend the use of cough and cold products that contain an antihistamine or decongestant in children younger than 2 years 3, 4.

Safety and Efficacy Concerns

• Studies have shown that many cough remedies lack clear evidence of their efficacy and safety in pediatric populations 5, 6, 7.
• The use of antitussive medications in children can lead to serious adverse effects, including death, especially when used incorrectly 3, 4.
• In general, over-the-counter (OTC) antitussive medications should not be routinely used in children under 2 years of age 3.

Recommendations for Use

• Antitussives with minimal adverse profile and some evidence of benefit may be recommended after informed counseling in certain cases 3.
• Conservative therapies, such as nasal suctioning, humidification, and nasal saline, should be recommended over cough/cold product use for infants and children 7.
• Pharmacists should be knowledgeable about the risks and benefits of each therapy to make safe recommendations for patients and their families 4.