With respiratory illnesses on the rise for both adults and children, many families are turning to cough medications for much-needed seasonal relief. Cook Children’s Health Care System is providing essential safety guidance regarding Tessalon Perles (benzonatate) after seeing cases of accidental ingestion. While effective for older children and adults, health experts are highlighting the importance of strict storage and dosing to prevent accidental ingestion in younger children.

 “Tessalon Perles are used to treat cough for kids over 10 but no safe dosing for younger children has been established,” said Mariana Wilson, M.D., medical director, Cook Children’s Medical Center- Prosper hospitalist. 

Because these liquid-filled capsules can resemble candy, they pose a significant risk to toddlers. Clinical data shows that even a small amount of benzonatate can be toxic to a young child; a recent tragedy in Denton County has prompted local experts to remind families of the need for secure storage.

“Unintentional poisoning can happen to anyone, at any age,” said Klaressa Broughton, poison prevention program coordinator at the Center for Community Health. Broughton explains that these incidents, affecting children from birth through age 18, primarily involved medications and unspecified non-drug poisonings.

In 2025, Cook Children’s Medical Center - Fort Worth saw an increase of poisoning encounters: 1,031 cases compared to 818 in 2024. Broughton explains that the top poisoning for 2025 involved children of all ages from birth to 18 and were related to medication and unspecified non-drug poisonings.  

“If the capsules are chewed, then release of benzonatate from the capsule in the mouth can produce a temporary numbing of the mouth and choking could occur,” explained Wilson. “If parents find a chewed capsule, even if it’s not completely consumed, they should call poison control or come to the ED,” said Wilson.

Cook Children’s experts share what care givers should know to keep their children safe.

Symptoms of Overdose

Symptoms of a benzonatate overdose can appear rapidly, often within 15 to 20 minutes of ingestion:

• Restlessness
• Tremors
• Convulsions
• Coma
• Cardiac arrest

“With technology at our fingertips, it is easy to turn to the internet browser for answers, but this can lead to unclear next steps,” said Broughton. “Calling the poison center at 1-800-222-1222 is free, confidential and all calls are answered by specially trained nurses, doctors and pharmacists.”

If a child becomes unresponsive, call 911 immediately.

Tips for Poison Prevention: 

Safe Medication Dosing 

• Follow the dosing directions listed on the medication by using the appropriate measuring items, such as a medicine cup or oral syringe.
• Double dosing is NOT twice as effective, and in many instances can cause internal damage.
• Adult medications may be too strong for children and should not be given in half doses. Only give medicine to your child that is intended for children.
• Print the medication schedule to keep the right dosage for your family. 

Safe Storage 

• Many people leave medications on bathroom and kitchen counters as well as bedroom nightstands as a visual reminder to take them. Avoid unintentional injury and store medication up high, locked, and out of reach.
• Hang purses and personal bags up high so children cannot reach prescriptions, vitamins, or other regularly used medications.
• Remember, when visiting friends and family, it is ok to have an open discussion about safe storage. 

Safe Disposal 

• DEA Drug Take Back Day is on April 25th from 10 a.m.-2 p.m.
• Visit a medication drop box at a local pharmacy. For more information on poison prevention, visit www.meddropbox.org.
• The best disposal option is to find a drug take-back location, which may be found in retail, hospital, pharmacies, and/or law enforcement facilities.
• Removing any unused or expired medication in the home can reduce the risk of access. 

 Related Stories:

• Expert Tips for a Safe Spring Break: Poison Prevention
• Know When to Use Telemedicine, Urgent Care, or the ER for Kids
• The Ultimate Holiday Safety Checklist

The Texas Department of State Health Services (DSHS) has issued a health alert for pertussis, also known as whooping cough, for the second consecutive year. From January through October, more than 3,500 cases have been reported throughout the state. Initial data indicate that 85% of cases are pediatric.

Pertussis is a highly contagious respiratory infection, according to KidsHealth, an educational partner of Cook Children’s Health Care System. In children and adults, whooping cough often presents as a common cold in the early stages, with symptoms that could include congestion, fever, and a cough.

Alice Phillips, M.D., director of Ambulatory Quality and Safety at Cook Children’s Health Care System, explains that in infants, a coughing fit may cause them to struggle to catch their breath. They breathe in as hard as they can to get oxygen, creating the characteristic “whooping” noise. 

“In Texas, as of October 2025, there have been over 3,500 cases of whooping cough reported compared to 1,907 in 2024,” said Dr. Phillips. “With most cases occurring historically in November and December, more is likely to come.”

Children less than a year old are most at risk of complications, with infants less than two months old being at the highest risk. However, immunizations can protect the most vulnerable, Dr. Phillips explains.

“Vaccination is key to protecting your child,” said Dr. Phillips.

The Tdap and DTaP (diphtheria, tetanus, and pertussis) vaccine protects people from diphtheria, tetanus, and whooping cough. Dr. Phillips explains the difference between the two: DTaP is for children younger than 7 and Tdap for patients older than 7. 

Vaccine Recommendation:

As of October 2025, Cook Children’s Health Care System had 28 admissions due to whooping cough, with seven being infants less than 2 months old.

“Because of this, it is recommended that all adults caring for newborns receive a whooping cough vaccine booster,” said Dr. Phillips.

Adults do not present the same symptoms as children, making them vulnerable to giving an infant whooping cough. The American Academy of Pediatrics (AAP) recommends vaccines for protection.

Vaccine schedule:

• DTaP for infants: receive vaccines at 2, 4, 6, and 15 months.
• DTaP for Children: receive boosters to maintain their immunity at ages 4 and 6 years.
• Tdap for Children: 11 to 12 years.
• Tdap for Adults: Recommended during pregnancy or for adults who will be around newborn babies.

Treatment: Since bacteria cause whooping cough, antibiotics are the trusted standard of care by physicians, but early recognition is important for the best response to treatment and to prevent spread.

Symptoms: Infants may experience symptoms like struggling to breathe, unexpected intervals where breathing stops, and apnea.

Prevention:  In addition to getting vaccinated, there are other ways to prevent the spread of whooping cough.

• It is recommended to stay home for at least five days after starting antibiotics or at least 21 days if not treated.
• Washing your hands.
• Cover your mouth and nose when coughing or sneezing.
• Avoid close contact with a sick person.

If you think your child has pertussis or has been exposed, contact your pediatrician. If difficulty breathing occurs, call 911 or go to the nearest emergency department.

The FDA will require several changes to the labels of all prescription medicines containing these drugs:

• Codeine should not be used to treat pain or cough and tramadol should not be used to treat pain in children younger than 12 years.
• A label warning against its use in children younger than 18 years to treat pain after surgery to remove the tonsils and and/or adenoids.
• A recommendation against their use in adolescents between the ages of 12 and 18 years who are obese or have conditions such as obstructive sleep apnea or severe lung disease, which may increase the risk of serious breathing problems.
• Breastfeeding mothers should not take codeine or tramadol medicines due to the risk of serious adverse reactions in breastfed infants. These can include excessive sleepiness, difficulty breastfeeding, or serious breathing problems that could result in death.

“Opioid abuse has become a public health concern and should be addressed as such. The more awareness we have for providers and families the better the communication can be amongst the community,” said Artee Gandhi, M.D., medical director of the Pain Management Clinic at Cook Children’s.

Dr. Gandhi said tramadol has generally been considered a “safe” drug. However, the physicians in the pain clinic recognize it as an opioid with the same risks as medications such as codeine. In addition to the physiologic effects, there are the psychological concerns of addiction and overdose.

“Early exposure to opioids also increases the risk of misuse and abuse even if prescribed for medical reasons,” Dr. Gandhi said. “Adolescents do not have the cognitive ability to appraise the situation and deem the consequences of prolonged exposure. If prescribed by a physician they must be safe. It is the duty of health care providers to educate patients and families on the correct use of these medications.”

For more information

Cook Children's Pain Management improves the quality of life for our pediatric patients by providing a balance between medicine and therapy.