Is Dimenhydrinate (Diphenhydramine) beneficial for cough management in infants?

Dimentindene (Diphenhydramine) is NOT Recommended for Cough Management in Infants

Diphenhydramine and other antihistamines should not be used for cough management in infants due to lack of efficacy and significant safety concerns. 1

Evidence Against Antihistamine Use in Infants with Cough

Lack of Efficacy

• Multiple guidelines and systematic reviews consistently show that antihistamines provide minimal to no benefit for cough in children, particularly infants:
  • The CHEST guidelines (2020) explicitly state that over-the-counter cough medications have little to no benefit in controlling cough in children 2, 1
  • A systematic review found that antihistamines were no more effective than placebo in relieving symptoms of acute cough in children 3
  • In contrast to adults, "the efficacy of antihistamine agents in relieving cough in children is minimal, if any" 2

Safety Concerns

• Significant risks associated with antihistamine use in infants include:
  • Serious adverse events and deaths have been reported with cough and cold medications in children under 2 years 4
  • During 2004-2005, an estimated 1,519 children under 2 years were treated in U.S. emergency departments for adverse events related to cough and cold medications 4
  • The FDA and other regulatory authorities have issued warnings against using these medications in young children 1, 5

Recommended Approach to Infant Cough Management

For Acute Cough (<4 weeks)

1. Identify and treat the underlying cause rather than suppressing the symptom 1
2. Avoid all over-the-counter cough medications including antihistamines in infants 1, 5
3. Ensure adequate hydration and monitor for signs of respiratory distress
4. For infants over 12 months, honey may offer some symptom relief (never use in infants under 12 months due to botulism risk) 1

For Chronic Cough (≥4 weeks)

1. Evaluate for specific underlying causes rather than treating symptomatically 2
2. Follow a diagnostic algorithm based on cough characteristics:
   • If wet/productive cough persists, consider protracted bacterial bronchitis and appropriate antibiotics 2
   • If cough occurs with feeding, evaluate for aspiration 2
   • If GI symptoms are present, manage according to GERD-specific guidelines but avoid acid suppressive therapy solely for cough 2

Important Caveats and Pitfalls

• The dosages at which cough medications can cause illness or death in infants are not established 4
• FDA-approved dosing recommendations do not exist for children under 2 years 4
• Even when parents report effectiveness, this likely represents the natural resolution of symptoms rather than medication effect 3
• Combining multiple cough and cold products can lead to overdose when they contain the same active ingredients 4
• For chronic cough, empirical treatment approaches without identifying the underlying cause should be avoided 2

Remember that while cough is distressing for both infants and parents, the risks of antihistamines like diphenhydramine outweigh any potential benefits, and evidence-based management should focus on treating the underlying cause rather than symptom suppression.