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Cough and Colds

Cough and Colds: What it is, common over the counter medicines and when to consult a doctor | KKH

Cough and Colds - What it is

Use of Cough & Cold Medicines in Young Children

Although most cough and colds in young children do not have serious complications; they are often worrisome to parents and are among the top reasons to visit a doctor or even self-medicate children with over-the counter (OTC) cough and cold medicines.

However, questions have been raised about the safety of these preparations. The current recommendation of Health Sciences Authority (HSA) is to seek advice from healthcare professionals before using these products in children, especially those under the age of 2 years. This is because potentially life-threatening side effects such as death, seizures, rapid heart rates and decreased levels of consciousness can occur in very young children if cough and cold medicines are wrongly given to them.

What are cough and cold medicines?

Common OTC drugs available for cough and cold include decongestants, antihistamines, cough suppressants (antitussives), mucolytics and expectorants. Many of these cough and cold medicines are also available as combination preparations and contain multiple ingredients to treat other symptoms such as nasal congestion, cough and fever concurrently. If one is not careful, giving more than one of these preparations could possibly cause duplication of doses or medicines and may result in an overdose.

Cough and cold preparations can also cause drowsiness and sedation. For example, antihistamines which are commonly used for cold can be categorised as sedating and non-sedating. Take extra precautions when taking sedating antihistamines as they can cause drowsiness, dizziness and incoordination. Excessive doses in children have led to life-threatening breathing problems and in very severe cases; may result in coma and death.

Discuss with your pharmacist when purchasing OTC medications to ensure safe and appropriate use. The pharmacist can also advise on the side effects to look out for; and when to seek medical attention.

Safety of Cough and Cold Medicines in in children under 2 years old.

There are limited benefits in giving cough and cold medications to children less than 2 years old. In fact, most OTC medications are not recommended for children under 2 years old. We shall discuss the use of some of these preparations here.

Cough preparations

Coughing is a normal symptom of cold and can help the body to clear the mucus out of the airways. They usually go away in a week or two without needing medications. OTC medications may relieve symptoms but will not make it go away quicker.

Cough preparations can be categorized into cough suppressants (for dry cough) and expectorants (for wet cough). Either cough preparations should not be given to children less than 2 years old; unless prescribed by the doctor who has assessed the benefits against the risks. In 2016; HSA has further issued restrictions on the use of codeine-containing products in order to reduce the risk of death and respiratory depression (potentially life-threatening breathing problems) in infants and children. They should only be used in children 12 years and above. Codeine is commonly used as an active ingredient for cough suppressants.

Mucolytics

These agents (e.g acetylcysteine) are used to treat productive or phlegmy cough by reducing the thickness of mucous, thereby facilitating the coughing up of mucus. However in very young children it may induce respiratory obstruction. Due to the physiological characteristics of the airways in this age group, the ability to cough up the mucous may be limited. Therefore, these agents should not be used in children under 2 years of age.

Antihistamines

These are usually used for cold symptoms and are often combined with decongestants to help clear blocked or stuffy nose. Antihistamines can be sedating or non-sedating. Although not recommended for use in children under the age of 2 as an OTC medication; it may be given in those over 6 months under medical supervision.

What can parents do?

These symptoms are self-limiting and most will get better without needing any medications. Ensure that the child gets plenty of bed rest and is kept warm. Nondrug treatments for coughs include drinking plenty of fluids, especially warm drinks to soothe the throat. For infants with a stuffy nose, use saline or saltwater drops/spray to moisten the nasal passages and loosen the mucus; then clean the nose with a bulb syringe.

Giving the Right Dose

If your child needs medication, remember that they are not mini ‘adults’, hence their dose is often based on their body weight. Use a syringe or medicinal cup/spoon to ensure accurate dosing. Do not use kitchen spoon to measure out liquid medication.

For more information on the safe use of medicines in children, visit the Pharmaceutical Society of Singapore website. (https://www.pss.org.sg/know-your-medicines/safe-use-medicines)

If you have questions or need advice, ask your pharmacist. Different products have different age recommendations; and some preparations may only be safe for older children or adults!

References:

  1. HSA Advisory. Restrictions on the use of codeine-containing products in children and adolescents. (20 Dec 2016) Accessed 28/11/20
    (http://www.hsa.gov.sg/content/hsa/en/Health_Products_Regulation/Safety_Information_and_Product_Recalls/Product_Safety_Alerts/2016/restrictions-ontheuseofcodeinecontainingproductsinchildrenandad.html)
  2. HSA Consumer Guide. The use of Cough & Cold Medicines in Children ( August 2009)
  3. FDA Consumer Guide. Most Young Children With a Cough or Cold Don't Need Medicines ( July 18 2017)

[This article is contributed by the Pharmaceutical Society of Singapore.]

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