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Kids' Cold Medicines: New Guidelines

For decades, parents have relied on kids’ cold medicines and cough syrups -- typically grape, cherry, or bubblegum flavored -- to ease their children's discomfort.

However, the FDA and manufacturers now say that over-the-counter cough and cold medicines should not be given to children under 4.

Evidence indicates that children's cold medicines don’t really help and may pose a real (although small) risk of side effects, particularly to young children. This has cast grave doubt on a common and trusted group of medicines. It’s left many parents anxious and confused.

Which kids’ cold medicines are in question?

Specifically, four different categories of drugs. They are:

Cough suppressants (dextromethorphan or DM)
Cough expectorants (guaifenesin)
Decongestants (pseudoephedrine and phenylephrine)
Antihistamines (such as brompheniramine, chlorpheniramine maleate, diphenhydramine [Benadryl] and others)

You might not recognize these drugs by name. But they are the active ingredients in many brands of kids’ cold and cough medicines.

What’s the problem with kids’ cold medicines?

One specific concern was that these medicines were often not studied in children. Instead, they were studied in adults, and those results were then applied to children. However, it’s not clear that adults and children will react to these medicines in the same way. Even in adults, the evidence that cough and cold medicines help is weak.

What are the risks of using kids’ cold medicines?

Experts agree that the risks from kids’ cold and cough medicines are low, especially considering how common they are. Millions of children take kids’ cold medicines every year. One study from 1994 showed that in a single 30-day span, more than a third of all U.S. children under 6 were taking a cold or cough medicine.

Still, about 7,000 children under age 11 go to emergency rooms each year after taking cough and cold medicines, according to the CDC. Roughly two-thirds of those ER visits occurred after children drank cough or cold medicine while unsupervised.

While the overall risks are low, some experts say that they are not low enough. Given that there’s no evidence that kids’ cold medicines help children, some consider any risk -- no matter how slight -- to be unacceptably high.

Many cases of dangerous side effects resulted from overdoses. But accidentally giving a child a dose that’s too high can be easy to do. Parents might use two different brands of kids’ cold medicines at once, not realizing that both contain the same ingredients. Or they might just measure out the dose incorrectly, especially when they’re groggy in the middle of the night, trying to soothe a sick child.

Should my child use kids’ cold medicine?

The current recommendations from the FDA are:

Do not use cold and cough medicines in children under the age of 4 unless your doctor tells you to.
Never give adult medicines to children. Only use medicines designed for children.
Never use a cold or cough drug if your child takes other prescription or over-the-counter medicines unless you’ve checked with the doctor first.
Carefully follow the instructions for dosing on the box.
Use the enclosed measuring spoon, dropper, or dosing cup.
Take your child to the doctor if symptoms worsen or don’t improve within a few days.

Also, many experts say that parents should go further and stop using any kids’ cold medicine in children under age 6 unless their doctors recommend it.

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