Cough medicine worries

Kids and Cough -- What You Need to Know About Your Child's Cough Medicine

For the record, I have to state I am not a medical professional and certainly not a doctor. The below information is not intended to diagnose or treat any medical conditions. For goodness sake, see your doctor already!

There are many products to help us with the common cough. Currently, some things you might find include:

antihistamines (eg, brompheniramine, chlorpheniramine, loratadine, and diphenhydramine) which help you to produce less mucus by blocking histamine. Most of them can cause drowsiness and some (such as diphenhydramine) are also packaged as both antihistamines (Benedryl) and sleeping pills (Unisom & Nytol). Later antihistamines, such as loratadine (Claritin) are supposed to be non-drowsy, although truthfully it can be said they cause drowsiness in a much smaller group of people.

decongestants (eg, phenylephrine and pseudoephedrine) which help dry you up by constricting blood vessels. Narrower blood vessels in your sinuses reduces inflammation, but narrower blood vessels elsewhere can be bad if you have conditions such as high blood pressure, arrythmia, or history of stroke. Phenylephrine used to be prescription only (as Entex) and it was pulled from the market voluntarily because a study showed it may increase the risk of stroke. But when the restrictions on pseudoephedrine (Sudafed) tightened to try and reduce the presence of meth (of which, Sudafed is a key ingredient), phenylephrine reappeared as a lower dose over-the-counter. Pseudoephedrine has been linked to heart attack and arrythmia at higher doses, which is why you no longer can buy "little white crosses" or "pink hearts" through the mail. Those "stay-awake pills" were nothing more than 60mg-120mg doses of pseudoephedrine.

antitussives (eg, codeine, dextromethorphan, and benzonatate) are supposed to reduce the cough reflex.

expectorants (guaifenesin) loosen mucus and help you cough it up.

HOW THE FDA AFFECTS YOU:
A little history is necessary to understand the problem we face with some cough medicines today. The original FDA in 1906 was concerned more with accurate labeling than drug safety, and primarily people were worried about dangerous food additives rather than medications. Food and drug labels had to be accurate, and the presence and amount of eleven dangerous ingredients, including alcohol, heroin, and cocaine, had to be listed. In 1938, a new act expanded the FDA to allow them to perform inspections, control cosmetics, and to make it illegal to make false or misleading claims about medical products. This also brought about the first prescription-only medications. But it wasn't until an amendment in 1962 that the FDA made it necessary to really prove the safety and efficacy of a drug before it went on the market. The problem was what to do about commonly used drugs that had been out long before 1962. Well, those drugs pretty much stayed on the market. That's why we have stuff like aspirin over-the-counter, even though we still aren't 100% sure exactly all that it does to the human body. In the past couple of years, the FDA has begun a program to evaluate and possibly remove drugs from the market that were brought out before 1962.

SAFETY OF COUGH MEDICINE QUESTIONED:
Between 2004 and 2005, the CDC reported more than 1500 emergency room visits in which children under two were given some form of cough medication. About 10 of 90 sudden infant deaths involved children under 12 months being given a cough medication, many of them were NOT under a doctor's supervision at the time. Even worse, various placebo studies over the last twenty years have indicated that cough medications simply don't work in young children, yet some doctors are unaware of these new studies. Children under 2 also don't have the ability to process codeine, making it much more lethal.

IMPORTANT NOTES TO REMEMBER! WHAT YOU NEED TO KNOW


* Don't give children medicine labeled for adults. Children process medications differently because their livers, etc. aren't fully developed. It is also more important to base children's medication on an accurate weight as they have less margin for error. Most bathroom scales are not terribly accurate.
* Buy products with child-resistant caps, but also keep medications out of reach of children and pets. Children are sometimes better at figuring out how to open a bottle than their adult counterparts. And I still tell with horror the tale of the woman who gave her new puppy a prescription of hers to play with. "But it was childproof!" she protested as I explained childproof did not mean puppy-proof. Sure enough, the dog ate the bottom of the bottle right off and then ate her pills and had to be rushed to the vet. I sure hope that woman never has children. Can you imagine giving your child a pill bottle as a fun rattle?
* Don't go by the brand name. Always check the ingredients list to make sure you aren't mixing two types of drugs. You can only take one of each category at a time. That means only one type of antihistamine, only one type of decongestant, only one type of pain medication. (Acetaminophen and NSAIDs are pretty much the only type of OTC pain medications which can be taken together on the same day, and that's another topic altogether.)
* I repeat, FOLLOW THE DIRECTIONS. Don't give more medication than is called for, especially not to your kids. More is not always better. In fact, cough medications may not even work on children as the final studies are still out.
* Use the measuring devices provided with the medication. Don't use regular silverware to measure out a spoonful. Even kitchen measuring spoons don't have to be all that accurate.



Medications are not the cure all for every ailment. People get sick, adults catch 2-4 colds a year and kids usually get 3-10 annually. That's NORMAL. And no medicine can cure the common cold, it only lessens the symptoms to make the cold bearable while it runs its natural course. If your child has a common cold, no medicine is required to make your child well. It will take care of itself in a few days. Now if your child exhibits symptoms that may point to something worse than a simple cold, contact their doctor right away. Don't wait! A phone call doesn't hurt anything and nurses on the phone will be able to tell you whether or not your child needs to be seen. Things to be concerned about include high fever (higher than 102), rash with fever, a cough or congestion bad enough to inhibit breathing, or a 'cold' that refuses to get any better after 3-5 days.