'I don't give cough medicines to my kids'

The last week in my house has been terrible.

Currently, I am the lone survivor of the war on Smith-Summertime-Flu-Like-Illness-2015.

You name the symptom and someone in my family has had it: fever, cough, runny nose, congestion, headache, sore throat, vomiting ... I could go on.

All of these symptoms are annoying. Running to grab the “puke bowl” when your 4 year old is “frowing up” is not my idea of a fun nor peaceful Wednesday evening. Trying to discern if his “headache” is really a headache, or fever or the early stages of some terrible bout with meningitis is not good for this pediatrician’s soul (nor his wife’s after she read this. It’s not meningitis, babe, I promise).

But the most annoying of all these symptoms for me is cough. When I have a cough, I generally try my best to keep it in for as long as I can, and let it go just before I feel like I’m going to drown in post-nasal drip. When my 6 year old has a cough, I’m pretty sure he feels like it is his duty to release that cough every five seconds. I think he does this just to remind me that he’s not feeling well and I haven’t given him anything to help.

Why don’t I give my kids cough medicines?

I don’t give cough medicine to my kids because they don’t work.

They really don’t.

Really.

The hard thing about this fact is that they were a staple of pediatric care for decades. Cough and cold medicines were first approved for use in children in 1976. There were no studies done to determine if they worked or what the appropriate dosing should be. I think the process back then went something like this:

“Why not give half the adult dose for children 5-12 and a quarter for the adult dose for children age 2-5?”

“Sounds good to me, let’s do this.” (Or maybe “Right on!” or “Groovy!” I don’t know, it was the 1970s.)

Since 1976 there have been several studies looking at the use of cough and cold medicines. The most recent review of the 25 best studies done stated this as a conclusion: “There is no good evidence for or against the effectiveness of OTC (over the counter) medicines for acute cough.”

I don’t give cough medicine to my kids because they can cause problems.

Side effects, even serious, even fatal ones, can occur as a result of giving kids (especially those under 6) cough medicines.

If you want to read some scary stories read these case reports from Pediatrics:

1. 3 year old ends up in ICU after becoming lethargic, having a slow heart rate, fast breathing and high blood pressure. Diagnosed with toxicity from Dimetapp (in this one we don’t know how much mom gave-could have been too much).

2. 3 year old being treated for pneumonia develops a fast heart rate, so fast that it start to interfere with the heart’s ability to work right. Parents were thinking they were giving Tylenol but ends up they were giving Tylenol Cold (acetaminophen, chlorpheniramine and dextromethorphan).

3. 9 month old boy is discharged from the ER with a diagnosis of pneumonia, doing well. Returns 12 hours later after being found cold, blue and not breathing. Unfortunately he dies after he is unable to be resuscitated. Toxicology on autopsy finds acetaminophen, pseudoephedrine, chlorpheniramine and dextromethorphan in the blood and heart tissue.

It is estimated that about 7.000 children are treated nationwide for toxicity related to cough and cold medicines and 64 percent of those are children under 6 years of age.

Everything in medicine is about weighing whether something works and if it could be harmful.

Cough medicines do not work and could cause harm, so my kids will pass.

P.S.

So will my patients because I don’t prescribe them either.