Many parents are worried if the familiar cough syrup is safe for their children following recent deaths in Madhya Pradesh and Rajasthan after it was administered to kids suffering from cold and cough. And just as the Health Ministry has said, it is not to be prescribed for children under two, doctors say it should not be given to children under six even. And that’s because a common ingredient in cough syrup, Dextromethorphan Hydrobromide, can cause side effects in children. Besides, the cough syrup does not work effectively enough in children. “Also, since cough syrups are easily available over-the-counter, parents may not be aware of the strict dosing that they require. No cough syrup should be used unless prescribed by the doctor. Do not use it beyond the days mentioned in the prescription,” says Dr Vivek Jain, senior director and unit head, Paediatrics, Fortis Hospital, Shalimar Bagh, Delhi. What is Dextromethorphan Hydrobromide? It is a common ingredient in numerous cough syrups intended for the control of dry cough due to its effects on the cough centre in the brain. It is generally safe and effective when given as instructed for adults. However, when not taken as recommended, Dextromethorphan Hydrobromide can pose a risk, particularly among children. Children are more vulnerable to even small overdoses or contaminants in medications because they are in stages of development and their organs have not matured. What causes deaths in children? The cause of the recent deaths is still under investigation but there are a few theories that experts have put forward. One theory is that the syrup was contaminated or otherwise adulterated in its manufacturing process. Another rather serious consideration revolves around inappropriate dosing or use. Giving adult formulations to children, or exceeding the recommended dose for a child, can result in significant and potentially fatal complications. Furthermore, children who may have unrecognised medical conditions would be more susceptible to a side effect from the syrup. Taking too much Dextromethorphan Hydrobromide can potentially result in some serious side effects including sleepiness, fast heart rate, seizures, liver damage or trouble breathing. In extreme cases, it may lead to coma or death. Even in recommended amounts, infants and children may have some negative reactions to the drug because their bodies are not able to metabolise it properly. What is a safe limit and what are warning signs for parents? I advise parents not to give cough syrup to any child, and especially those under six years, without a recommendation from a healthcare professional. Do not buy what the pharmacist recommends. Cough syrups by different manufacturers have different quantities of dextromethorphan per 5 ml of liquid, which expose a patient to overdosing. Pharmacists often substitute one brand with another without checking the quantity of dextromethorphan in the substituted brand. If given to a child, caregivers should always measure accurately with the dropper or cup provided. Using other spoons can lead to accidental overdoses. Parents and caregivers should also check the label of any cough syrup to make sure it is safe for the child’s age and should never give children multiple medications for colds without knowing it is safe to do so. Many cold medicines also contain Dextromethorphan Hydrobromide and could cause an overdose. Parents should treat all cough syrups as prescription medications, seek medical advice before use, and watch carefully for any response to the cough syrup. Those in authority should enforce strict quality control measures and insist upon similar composition so that we don’t experience such tragedies again.
