The Union Health Ministry has issued an advisory against prescribing or administering cough syrups for cold and cough symptoms among children younger than 2 years old, after the death of nineteen children in Madhya Pradesh and Rajasthan caused by the two contaminated cough syrups.
The alert points to increasing concerns with the inappropriate use and safety of these drugs in infants and young children. The health risks are severe — from toxicity to respiratory depression, said experts who note that for this age group there is scant evidence of benefit and intractable risk. The Ministry has asked states to maintain sharp vigil and safe medical practices for young babies.
“Cough syrups are not safe for infants and can be harmful, says Dr. Akram Syed, Pediatrician at Apollo Clinic Bellandur, Bengaluru. In infants and toddlers (younger than 2 years), the risk almost always outweighs the benefit, he adds.
Bodies are not fully developed
In a young child, liver and kidney function is still developing. This means drugs in younger children clear at a slower rate, so there is greater risk of drug accumulation, overdose or unexpected side effect.
Not proven to have benefit
Many cough syrups (especially those bought over the counter) have not proven to have efficacy in young children. Often the cough is viral, self-limited, and reducing the cough with medication does not change the course of illness
Increased risk for side effects
While taking cough syrup, there are chances of respiratory depression, drug interaction, and allergic reactions. A small miscalculation in doses can have significant consequences.
Risk associated with impurities or poor quality
In recent years there have been cases of fatal poisoning from cough syrup ingestion by children related to contamination (i.e. toxins like diethylene glycol).Cases like these have demonstrated the vulnerability of infants to dangerous situations.
Products that combine medications “cocktail formula”
Many cough syrups contain 2 or more medications for example antihistamines, decongestants, and cough suppressants hence for small infants or toddlers, the potential risk continues to increase without proven benefit.
Given all of this, it is important to refrain from using cough syrups in children under 2 years of age, and the only treatment is supportive care (fluids, humidified air, nasal suctioning).
If A Child is Older Than 2 years
When a child is greater than 2 years old, things shift a bit but still be careful. Here’s what one needs to take care of :
Always check with your pediatrician first.
Don’t give a drug without precedent. The doctor will determine the cause (viral, bacterial, allergy, postnasal drip), and determine if a drug is necessary or it is enough to observe your child.
Use single ingredient syrups, not multi-ingredient.
Using a single ingredient syrup like dextromethorphan or a mild expectorant (if indicated) is safer than a “cocktail” which may include a combination of a decongestant + antihistamine + cough medicine.
Use dose by weight, not “age” or eyeball.
A majority of errors occur for parents who overestimate their child’s dose. Always ask the paediatrician to specify mg/kg (or ml) dose and use the proper syringe or measuring cup.
Limit the duration of use
Use the medicine for the shortest duration possible (ex: for a few days at most). If the cough worsens or is associated with fever or difficulty breathing, go back in to see the doctor.
Watch carefully for side effects
Drowsiness, restlessness, changes in breathing, rash or excessive sedation are warning signs. If they happen, stop the medicine and seek medical attention.
Avoid certain ingredients
Some cough syrups contain decongestants, codeine, and very old antihistamines that are no longer recommended for use in children. The pediatrician should not use those.
Ensure that the product is safe and quality assured
Use brands that have had appropriate health authority approval, check the expiry dates and batch numbers, and do not use anything that is suspicious or too cheap. Manufacturing mistakes have precipitated tragedies in India.
Use supportive care in tandem
Medications will not replace measures like rest, fluids, humidification, saline nasal drops, and warm liquids, etc. These will often make the biggest difference.
Be aware of risk groups
If your child has asthma, any lung disease, heart disease, or they are dehydrated or malnourished, the tolerability to side effects is different and caution is advised.
Reassess frequently
If their symptoms do not show any improvement in 48-72 hours or if the cough changes character (increases in severity, produces blood, or is associated with difficulty breathing), the child should be re-assessed with the paediatrician.
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