July 6, 2004 -- For kids, and their parents, the most bothersome symptom of respiratory infections is often the miserable cough that accompanies it. Cough is the No. 1 reason for pediatric visits, and billions are spent each year on over-the-counter cough medicines.
Although cough suppressant medications such as codeine and dextromethorphan areeffective in adults, their effectiveness in children hasn't been known. Now, research suggests that over-the-counter cough suppressants may be no more useful for calming a cough in children than simple sugar syrup.
"Nighttime coughing affects the child and the parents. Nobody gets any sleep," lead investigator Ian M. Paul, MD, tells WebMD. "Even so, parents really need to think twice before giving these medications that have doubtful positive effects on their children's symptoms and may have a potential for side effects."
All Kids Improved
The most widely used active ingredient in over-the-counter cough medications, dextromethorphan, is found in Robitussin and more than 120 other over-the-counter cough suppressants.
The study involved 100 children, ages 2-18 years, with a cold and bothersome nighttime coughing treated at practices affiliated with Penn State Hershey Medical Center. The children received either the dextromethorphan-containing medication Benylin, the diphenhydramine-containing drug Diphen AF, or a placebo sugar syrup. Parents were told to give the medications 30 minutes before the child's bedtime, and neither the parents nor the doctors knew which preparation each child was getting.
During the study, all children showed dramatic improvements regardless of which treatment they received. Parents reported that not only did coughing improve, but that everyone slept better once treatment began. The findings are published in the July 1 issue of the journal Pediatrics.
Paul tells WebMD the fact that colds improve with time may have more to do with symptom relief than the medicines given to treat it. The children in the study had been sick for an average of four days before treatment was started.
"We know that colds get better with time, and we found that these children improved to a similar extent regardless of the treatment they received," he says.
Potential for Abuse
Over the past few years, over-the-counter cough medications containing dextromethorphan have become popular drugs for abuse among teens. These medications, when administered to children, have been associated with irritability,restlessness, lethargy, hallucination, and hypertension. Scores of overdoses and at least five deaths have been attributed to the medications, and they are often combined with alcohol or other recreational drugs.
Paul says the potential for abuse is another reason to question the widespread availability of over-the-counter cough medications.
Nashville pediatrician Veronica Gunn, MD, who has also studied the use of over-the-counter cough medications in children, says it is understandable that parents want to try something to relieve their child's cough.
"I try to be empathetic because when a child is coughing all night, nobody sleeps," she says. "I am certainly not a proponent of giving cough and cold medications, but I tell my parents that if they are desperate to try something I will support them."
In these cases, Gunn recommends choosing an over-the-counter medication with a single active ingredient instead of one with multiple ingredients marketed for the relief of a host of cold-related symptoms. And she recommends limiting use of the medications to no more than three days.
"One child I wrote about suffered heart damage after being on a cough and cold drug for just over a week," she says. "The damage was repaired over time, but that is not something you want to expose your children to for no good reason."