Although reducing a medication dose to account for lower body mass enables the use of some common drugs in children, for other drugs the right dose in kids is none at all. That’s likely to seem counter-intuitive to parents and grandparents who have relied on cough medicine for babies and young infants for years.

While caregivers may note that infant formulations are no longer on the shelves, they may think that using less of the version approved for older children will be fine. As a pharmacist, you can help them understand why the FDA no longer approves any OTC cough medication for children under age 4 years and help them find other options that make the little ones feel better and allow all members of the household to get some sleep.

Cough and cold medicines “offer little benefit to young children—and can have potentially serious side effects,” according to the American Academy of Pediatrics. Common ingredients may harm infants and toddlers, in particular. Dextromethorphan, for instance, inhibits coughing by suppressing activity in the medulla and limiting reuptake of serotonin. Those mechanisms of action expose small children to a significant risk of severe respiratory depression and serotonin syndrome, according to the Indiana Pharmacists Alliance.

Cough medicines that contain codeine or hydrocodone should not be given to anyone under age 18 years. Both ingredients can slow breathing and pose a life-threatening risk to children. Topical medications that work by releasing antitussive vapors may also pose a risk to infants, and most are not approved for use in children under age 2 years. Formulations that contain camphor can increase mucus production and may cause rebound congestion and obstruction of small airways. Versions formulated specifically for babies may not have these side effects because they do not include camphor, but their efficacy is unknown.

How can you alleviate the distress caregivers experience when a young child has a cough? A little education may help. “Coughs are a normal symptom of a cold and help the body clear the mucus out of the airway and protect the lungs,” says the FDA. Both colds and coughs generally resolve by themselves in a week or two without medication.

More active interventions may also help the child. Drinking plenty of liquids will help thin mucus and warm liquids may soothe a throat strained from frequent coughing. The Mayo Clinic notes that one study showed that in children age 2 years and older, two teaspoons of honey at bedtime reduced nighttime coughing and improved sleep. Honey is not recommended for children under the age of 1 year, though, because of the risk of infant botulism. Cool mist humidifiers can reduce congestion that may be contributing to a cough.

While most coughs are no reason for alarm, sometimes they signal a more serious illness. Caregivers should be encouraged to contact their child’s pediatrician any time a cough occurs in an infant age 2 months or younger or in conjunction with a fever of 102 degrees Fahrenheit or more, blue lips, labored breathing, wheezing, fast breathing, excessive crankiness or sleepiness, or when the ribs show on inhalation. In addition, caregivers should call a healthcare provider if the  infant has a cough that lasts more than 3 weeks or gets worse.

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