Cough Syrup for Kids

Living Well in Myanmar

Cough syrup for kids, not so sweet

One of the hardest parts of being a responsible doctor for children is advising parents to refrain from giving certain types of medicines.  This becomes particularly challenging when kids develop colds, as they appear to be suffering when they cough and they keep their families awake all night with their symptoms.  Parents naturally respond by purchasing a cough syrup or other remedy.  But are these medicines safe and effective for use in children?

The simple answer is “no”.  Many of the cold medicines available at the drug shop have never been studied in children and therefore have never been proven to be safe.  Furthermore, when cold medicines have been researched in children, they consistently show no advantage over placebo in length of symptoms, severity of cough, or quality of sleep for child or parent.  All of the following types of cold medicines have been proven to be ineffective:  antihistamines, antihistamines with decongestants, antitussives, antitussives with bronchodilators, medicines containing dextromethorphan, and Echinacea.  This encompasses the range of products available from the global pharmaceutical companies that sell western medicine.

More worrisome for parents and children is the accumulating evidence that the availability of over-the-counter cold medicines are dangerous for kids.  The problem is primarily that caregivers may choose one medicine for fever and then another for cough, when in actuality both medicines have the same ingredient.  The resulting exposure to high levels of an active ingredient can lead to overdose.  Because of the high number of children admitted to American hospitals with cough medicine overdose, the US Food and Drug Administration has recommended that cough and cold medicines never be used in children under 4 years old.  The American Academy of Pediatrics has extended the warning stating, “… the medications are not effective for children younger than 6 years and their use, and misuse, could cause serious, adverse side effects.”

The good news is that western medical research has identified a product that is safe and effective in treating cough, and perhaps your child already likes it – honey.  Several studies have supported using honey at bedtime to help a coughing child, and in 2012 a double-blind randomised control trial – the gold standard in medical research – confirmed that kids cough less frequently and less severely, find the cough less bothersome, and that both they and there parents sleep better.  A possible mechanism for the effectiveness of honey is it that soothes the throat while also having antioxidant and antimicrobial properties.  The appropriate amount to give a coughing child is half a teaspoon for under 5 years old, one teaspoon for 6-11 years old, and two teaspoons for children greater than 12 years old.  Children less than 1 year old should not get honey because of the risk of botulism [a toxic reaction to bacteria].

Health care providers in Myanmar face a formidable challenge in spreading this knowledge to the public.  Advertising for unsubstantiated health products is omnipresent across the country.  Parents with even minimal disposable income want to purchase medicines for the health of their children.  However appropriate public health messaging to guide parents is absent.  The notion that honey is more effective and safer than packaged pharmaceuticals will likely be slow to gain acceptance.  © Christoph Gelsdorf 2013