Handling Children’s Coughs and Colds Safely

A baby with a stuffy nose is a cranky baby, and any new parent will tell you that colds keep their babies up all night, crying and miserable. We adults have plenty of options when it comes to coughs and colds – there is an entire aisle dedicated to those products at the drugstore. Decongestants, cough suppressants, antihistamines and mucus reducers: we can get them in pills and liquids and fizzy tablets to keep us going through a cold. But what’s a parent to do when it’s the baby who’s congested and coughing?

As much as it would be nice to be able to offer our babies the same relief we enjoy from those medications, parents should stay away from the cough and cold aisle when the baby’s sick. The FDA has put out warning after warning after warning about how cough and cold medicines are not safe for infants.

Serious Concerns About Safety

In October of 2007, the Consumer Healthcare Products Association (CHPA), on behalf of the manufacturers of the most common over-the-counter cold medicines, initiated a voluntary market-wide withdrawal of all cough and cold products marketed for infants. They did that in part because the FDA put out strong warning statements recommending against using those drugs in children under 2 years of age. (Many manufacturers later voluntarily increased the age on the warning label to 4 years of age.) After years of collecting reports of adverse events in infants who’d been given cough and cold medicines, there was enough evidence to support pulling the drugs from the shelves. Some of the serious side effects that were reported included rapid heart rate, altered states of consciousness, and convulsions. Even though it’s “just” cold medicine.

Unfortunately, the recall didn’t remove all of the risk to infants, because most of those cold medicines remain available on the drugstore shelves today, marketed at older children. While they all carry clear warning labels stating that they shouldn’t be used in children under 4 years of age except with a physician’s approval, the FDA is still receiving reports of dangerous and life-threatening side effects in infants because some parents don’t read the labels, or assume that it’ll be okay if they halve the big-kid dose and only give their infant a little bit.

It’s not that parents are stupid, or deliberately giving their babies dangerous medications. These FDA guidelines have only recently changed, so parents with older children may be acting on out-of-date information that was true a decade ago when their first baby was sick with a cough. And parents who are giving cold medicine to their preschoolers may think nothing of giving the same thing to their youngest child: it’s not necessarily obvious why it should be safe for one age group and not the other. Many medication labels list the dosages by both age and weight. A parent with a big baby might go by the weight on the label instead of the age, and assume that since the child fits into a category on the dosing chart, it’s safe for them to take the medicine.

More Medicines Than They Need

Cough and cold medicines contain a wide variety of active ingredients, often in combinations so that a patient doesn’t need to buy several different bottles. Cough medicines can contain mixtures of cough suppressants and expectorants (to loosen mucus). Decongestants can contain antihistamines and analgesics. Some even contain sleep aids to help you get through along night without being woken up by a cough. The biggest danger to infants is when they’re given more than one medicine and they’re accidentally overdosed because the medicines contained the same active ingredient. The misconception that a kitchen spoon is equivalent to 5ml (teaspoon) or 10mL (tablespoon) makes overdose even more likely, as the actual volume of spoons varies dramatically. While an extra mL of cough syrup isn’t likely to hurt an adult who’s using a spoon to measure, an infant only weighs a tiny fraction of what an adult does, and the additional dose in that one mL might be too much for their body to handle.

The danger is serious enough that it’s especially important that pediatricians approach this subject at well-child visits, before the child comes in sick.

If your baby is up late at night with a stuffy nose and a miserable cough, check with your pediatrician before buying and administering any kind of cold medicine. Always read the dosages and warnings on the labels carefully, and always administer medications using a graduated syringe or measuring device supplied with the medication – never a teaspoon or tablespoon. But considering that there’s very little evidence that cold medicines have a noticeable effect even in adults, it’s likely safest to stick with the nonmedicinal options. Cool mist humidifiers can help coughs and congestion, and saline drops (or a gentle saline spray) and a nasal suction bulb can go a long way to clearing out the nasal passages for a better night’s sleep.

Updated Oct. 2, 2016 to note that most major prescription drug manufacturers voluntarily increased the age on their warning labels to 4 years of age.