Cold and Cough Medications for Children: Dangerous and Over the Counter!

Young children have cold symptoms multiple times per year, which are usually part of a viral upper respiratory illness. Fever is commonly associated with these viral upper respiratory infections and is one of the most frequent chief complaints for children presenting to an emergency department. Cold and cough medications (CCMs) are widely marketed and used for the relief of cold symptoms. Studies have not found the ingredients in CCM to be beneficial for symptom relief. Both the Food and Drug Administration and American Academy of Pediatrics have recommended against the use of CCM in young children younger than 2 years, citing a lack of efficacy and potential for harmful side effects. Clinical toxicity and death have been reported both with therapeutic use, misuse, and overdose. In addition to unintentional harm, CCM can be misused and/or abused. The purpose of this article is to review the classes of medications found in over-the-counter CCM, the epidemiology of their use, the pharmacology and clinical toxicity of specific medications, dextromethorphan abuse, and the management of children presenting with overdose or adverse effects.