Bromfed Dosing for a 6-Year-Old Child
Bromfed (brompheniramine/pseudoephedrine/dextromethorphan combination) should NOT be used in a 6-year-old child due to FDA safety warnings against over-the-counter cough and cold medications in children under 6 years of age, with 33 deaths attributed to diphenhydramine (a similar first-generation antihistamine) in this age group between 1969–2006. 1
Critical Safety Concerns
The FDA's Nonprescription Drugs and Pediatric Advisory Committees explicitly recommend against using OTC cough and cold medications (including first-generation antihistamines like brompheniramine) in children below 6 years of age. 1
Between 1969 and 2006,69 deaths were associated with antihistamines in children under 6 years, with first-generation agents like brompheniramine carrying similar risks to diphenhydramine. 1
A fatal case report documented an infant death from a pseudoephedrine/brompheniramine/dextromethorphan combination product, with postmortem blood levels of brompheniramine at 0.40 mg/L and pseudoephedrine at 14.4 mg/L. 2
Overmedication with pseudoephedrine/dextromethorphan combinations has resulted in serious neurologic toxicity including hyperirritability, psychosis, and ataxia in a 2-year-old child. 3
Why This Combination Is Particularly Problematic
Multi-ingredient cough and cold products dramatically increase overdose risk in young children due to medication errors, accidental ingestions, and use of multiple products simultaneously. 1
The American Academy of Pediatrics recommends avoiding over-the-counter cough and cold medications in all children under 6 years due to lack of proven efficacy and significant potential toxicity. 1
Dextromethorphan efficacy for treating acute cough is uncertain and not supported by the American Academy of Pediatrics, despite widespread use. 4
Safer Alternative Approach for a 6-Year-Old
For Allergic Symptoms (Rhinitis, Urticaria)
Use second-generation antihistamines as first-line therapy: cetirizine 5 mg once daily OR loratadine 5 mg once daily for children aged 6 years. 1
Second-generation antihistamines (cetirizine, loratadine, desloratadine, fexofenadine, levocetirizine) have demonstrated excellent safety profiles and are well-tolerated in children. 1
For Cough Symptoms
Avoid antitussive medications entirely in this age group; focus on supportive care, hydration, and humidified air. 4
If cough is severe and requires medical intervention, consult a pediatrician for evaluation of underlying causes rather than empiric OTC medication use. 1
Common Pitfalls to Avoid
Never use combination cough and cold products in children under 6 years, even if the child appears older or larger than average for their age. 1
Do not assume that "pediatric formulations" are safe—the FDA warning applies to all OTC cough and cold products regardless of marketing. 1
Avoid using these medications "as needed" or for sleep aid purposes, as both are explicitly contraindicated and dangerous. 1
Be aware that brompheniramine has a 12.4-hour elimination half-life in children, meaning toxicity can be prolonged if overdose occurs. 5