The American College of Chest Physicians (ACCP) has just published new comprehensive evidence-based guidelines for the treatment of cough in adults and children. These guidelines recommend that cough medicines not be used in children because they do not help the symptoms and they can cause harmful or fatal side effects.
Since 1997, the American Academy of Pediatrics has stated that there is no evidence that cough medicines, particularly codeine and dextromethorphan, help cough in children, and has warned that they can have harmful side effects. Numerous studies and reviews since then have confirmed this recommendation. However, the recommendation from the ACCP against using them is the first such recommendation.
People, including parents, generally believe that over-the-counter medications must be safe. However, most people do not realize that many of these drugs (and many prescription drugs as well) are actually not approved or regulated by the FDA. The FDA has guidelines for cough and cold medicines in children over the age of 2 years, but none exist for infants and toddlers less than 2, despite the numerous products marketed for infants and toddlers.
Drug manufacturers are aware of the lack of evidence that cough medicines are effective. A pediatrician who serves as a medical affairs director for the manufacturer of the Robitussin brand agrees that there are few data to support the effectiveness of cough medicines in children and that it may be simply a “placebo effect”, where the person believes it makes them or their child better.
The ACCP guidelines also state that cough suppressants and expectorants are not effective in adults as well, and recommend antihistamine/decongestant preparations for adults; however, these are not recommended in children due to harmful side effects.
Evidence and expert recommendations continue to increase against using cough medicines in children. Parents should be aware that these medicines do not help to relieve cough in children. Warm liquids, lozenges or hard candy, corn syrup, and decongestants in older children are much more effective, safe, and economical. I think older children can try cough medicine to see if it helps, but parents should not be surprised if they have little or no effect on their child's cough.
