Should I give my child Pinex (dextromethorphan) for their cough?

Should You Give Dextromethorphan (Pinex) to Your Child?

No, you should not give your child dextromethorphan (Pinex) for their cough—the American Academy of Pediatrics specifically advises against using dextromethorphan for any type of cough in children, as it provides no more benefit than placebo and carries risk of adverse events. 1

Why Dextromethorphan Should Be Avoided

The evidence is clear that dextromethorphan does not work in children:

• Multiple high-quality studies demonstrate that dextromethorphan is no different than placebo in reducing nocturnal cough or sleep disturbance in children 1, 2
• Systematic reviews conclude that over-the-counter cough medications (including dextromethorphan) have little, if any, benefit in the symptomatic control of acute cough in children 3
• In a direct comparison study of 100 children, neither dextromethorphan nor diphenhydramine produced superior benefit compared to placebo for cough frequency, severity, or sleep quality 2

Safety concerns make the risk-benefit ratio unfavorable:

• Dextromethorphan preparations have been associated with adverse events, including reported deaths from toxicity in young children 3
• Insomnia was reported more frequently in children given dextromethorphan 2
• Over-the-counter medications are common causes of unintentional ingestion in children under 5 years 1

What You Should Give Instead: Honey

For children over 1 year of age, honey is the recommended first-line treatment:

• Honey provides more relief for cough symptoms than no treatment, diphenhydramine, or placebo 1
• A clinical trial of 139 children demonstrated that a 2.5 mL dose of honey before sleep had significantly more alleviating effect on cough compared to dextromethorphan 4
• The mean cough frequency score improved from 4.09 to 1.93 with honey, compared to 4.11 to 3.11 in the control group 4

Critical safety warning: Never give honey to infants under 12 months of age due to risk of infant botulism 1

Age-Specific Guidance on OTC Medications

The FDA and American Academy of Pediatrics provide clear age cutoffs:

• Under 4 years: Should NOT use over-the-counter cold medications due to potential toxicity and lack of proven efficacy 5
• Ages 4-6 years: OTC cold medications should generally be avoided 5
• 6 years and older: May use according to package directions, but benefits remain limited 5

Between 1969 and 2006, there were 54 deaths associated with decongestants and 69 deaths associated with antihistamines in children under 6 years 5

When to Seek Re-evaluation

Most acute coughs are self-limiting, but reassessment is needed if:

• Cough does not resolve within 2 to 4 weeks—the child should be re-evaluated for emergence of specific etiological pointers 3
• The child is deteriorating or not improving after 48 hours 1
• High fever (≥38.5°C) persists for more than 3 days, which may warrant consideration of antibiotics 1

Common Pitfalls to Avoid

• Prescribing OTC medications due to parental pressure: Parents who desire medication at the initial visit report more improvement at follow-up regardless of whether the child received medication, placebo, or no treatment—this is a perception effect, not actual efficacy 1
• Assuming all cough needs medication: In otherwise healthy children without chronic conditions like asthma, symptoms of acute upper respiratory infections are generally mild and self-limited 6
• Using multiple products: Common causes of adverse events include use of multiple cold/cough products containing the same ingredients 5

The Bottom Line on Your Question About Honey

Yes, the recommendation about honey being effective is correct, and this is precisely why you should NOT give dextromethorphan (Pinex). Honey has proven efficacy while dextromethorphan does not, making honey the evidence-based choice for children over 1 year of age with cough. 1, 4