Is glycerol 0.75 percent (glycerin) effective and safe for treating cough in infants?

Glycerol 0.75% for Cough in Infants

Glycerol 0.75% is not recommended as a standalone treatment for cough in infants due to insufficient evidence of efficacy and safety concerns regarding over-the-counter cough medications in this age group. 1, 2

Safety Concerns with Cough Medications in Infants

The use of cough medications in infants raises significant safety concerns:

• The FDA and manufacturers have issued warnings against using over-the-counter (OTC) cough medications in children under 4 years of age due to potential serious side effects and lack of proven efficacy 1
• In 2005, infant deaths were reported in association with cough and cold medications in infants under 6 months 2
• The dosages at which cough medications can cause illness or death in children under 2 years are not well established 2

Evidence Regarding Glycerol

While glycerol is often included in cough syrups as a component, its specific use at 0.75% concentration for infants lacks robust evidence:

• Glycerol may have properties that could theoretically help with cough, including lubrication, demulcency, sweetness, and acting as a humectant 3
• However, these properties have not been adequately studied specifically in infants to establish safety and efficacy profiles 3

Recommended Approaches for Infant Cough

For infants with cough, the following evidence-based approaches are recommended:

• Conservative therapies should be prioritized, including:

  • Nasal suctioning
  • Humidification
  • Nasal saline 4

• Adequate hydration to help thin secretions 1

• Elimination of environmental triggers such as tobacco smoke exposure 1

• Avoid honey in infants under 12 months due to risk of botulism 1

Management Algorithm for Infant Cough

1. Assess for warning signs requiring immediate medical attention:

   • Difficulty breathing
   • High fever
   • Cyanosis
   • Lethargy
   • Poor feeding

2. Implement conservative measures:

   • Ensure adequate hydration
   • Use nasal saline drops followed by gentle suctioning
   • Maintain proper humidification in the infant's environment

3. Monitor for persistence or worsening:

   • If cough persists beyond 2-4 weeks, medical evaluation is recommended 1
   • For GERD-related cough, follow GERD-specific guidelines rather than using cough medications 5

4. Avoid medication use:

   • Do not use OTC cough medications in infants 1, 2
   • Do not use acid suppressive therapy solely for cough 5

Important Considerations

• The American College of Chest Physicians emphasizes treating the underlying cause rather than just suppressing the cough 1

• For infants with chronic cough (>4 weeks) without underlying lung disease but with GI symptoms suggestive of GERD, treatment should follow evidence-based GERD-specific guidelines rather than using cough medications 5

• Parents should never administer cough medications to infants without first consulting a healthcare provider 2

• The management of cough in children should be etiologically based, as the causes and appropriate treatments differ significantly from those in adults 6

In conclusion, while glycerol is a component in many cough syrups, there is insufficient evidence to support the use of glycerol 0.75% specifically for cough in infants, and the risks associated with cough medications in this age group outweigh potential benefits.