Amid the child deaths in Madhya Pradesh and Rajasthan due to contaminated cough syrups, parents are becoming increasingly anxious about whether they should give cough syrup to their children at all. The rules, doctors say, are fairly simple. Since cold and cough in children are mostly self-limiting, there is no need to administer cough syrups to those under six years of age. Also, since dosing is different for adults and children, always use a cough syrup as prescribed by the physician instead of buying any bottle over the counter on the pharmacist’s suggestion. Dr Pankaj Hari, head of paediatrics department, All-India Institute of Medical Sciences (AIIMS), Delhi, says, “Unless contaminated, cough syrups cannot cause death if medical protocol is followed. Syrups with Dextromethorphan Hydrobromide, which is a key and very common active ingredient in over-the-counter cough syrups and other cold medicines, is not harmful. It is a cough suppressant and works by blocking the cough reflex in the brain. You don't develop kidney failure because of it,” he says. When should children be given cough syrups? Cough syrups are of two kinds: One of them is a cough suppressant and the other is a decongestant. Cough suppressants are for dry cough, which can be a distressing condition. Decongestants are different; they reduce nasal congestion, particularly a runny nose. They also help when a cough is triggered by nasal congestion and nasal discharge. Generally, both are not to be given to infants and toddlers. In the US, doctors do not prescribe them for children under four. Not that we have not administered it ever but those were in a few select cases under strict supervision. That too in cases where the child is two years and above. Problems arise in India because cough syrups are over the counter drugs, easily available without the doctor’s prescription. So the family goes and buys the syrup themselves which should be avoided. Buy it only when the doctor prescribes. What are side effects of overdosing? If taken in large amounts, it will cause sedation, drowsiness, pace up heart beats and sometimes trigger vomitting and nausea among children. If overdosing happens in adolescents, they could get a ‘drug high’, get addicted to it and wrongfully use it as a mood elevator. What about dosage for children? First of all, a general physician will not know the dosage per milligram that we paediatricians use. So always get a prescription from a paediatrician or child specialist. It is prescribed in milligrams per kg for children. Generally, it is 0.5 to 1 milligram per kg body weight and it should not be given more than thrice daily. Use a dosing spoon that comes with the bottle. If you give them a teaspoon or a tablespoon of syrup, that causes overdosing. If the doctor has to prescribe it in a special situation where the child is under four years, then he has to write the specific dosage on the prescription. What should we look for when we are buying a cough syrup bottle? Generally, you will find dextromethorphan, a cough suppressant, and two decongestants that are often used in combination with suppressants, phenylephrine and pheniramine. Always buy syrups that are labelled and manufactured by standard pharma companies. Companies who manufacture cheap drugs don’t label it and supply the syrups in cans. There they use diethylene glycol as a solvent, which is toxic. This contamination can happen in paracetamol and other medicines where propylene glycol is used. Dextromethorphan does not cause kidney failure. It is not a nephrotoxic drug, only diethylene glycol causes kidney injury. So what are other cough relief alternatives? The other alternative is dexamethasone, which is the second antihistamine-phenylephrine and chlorpheniramine. The FDA says even these should be avoided in children less than two years of age. So this means that there are no alternatives for infants. Homemade remedies can be tried like taking honey, steam and humidified air. And if there is nasal congestion, then use saline nasal drops, which do not contain any medicine.
