Over the counter medication (OTC) refers to medications that can be bought without a prescription. It is a rare household indeed that does not contain several of these medicines. Unfortunately, this widespread availability and use suggests these medications are also safe. However, an overdose of an OTC “cold” medication is not an uncommon diagnosis to find in a Pediatric Intensive Care Unit, especially in younger children.
Acetaminophen (aka Tylenol), ibuprofen (aka Motrin), dextromethorphan (aka Robitussin), a variety of antihistamines, and the decongenstant psuedoephedrine (aka Sudafed) have been available for many years over the counter. These medications are far from harmless. Acetaminophen poisoning can cause rapid fatal liver failure. Aspirin, which is no longer recommended for use in children, was once a leading cause of childhood death from poisoning. Ibuprofen can be harmful to the kidneys. Antihistamines
can cause a variety behavior problems from lethargy, to agitation, to hallucinations. The recommended doses of cough and cold mixtures are based on adults research only and extrapolated to children. Dextromethorphan has not been shown to decrease cough in
children compared to placebo (ie no medicine). Also, some products - such as infant acetaminophen drops and pediatric acetaminophen syrup - have very different concentrations of medication and incorrect use has lead to overdose. Likewise MANY products contain more than one medication (the “cough and cold” formulas) which, in addition to the confusing labels, can result in overdosing from giving the same medication from two sources. These mixtures also subject children to medications they don’t need. Lastly, some forms of medication, usually elixirs, contain up to 25% alcohol as well.
These concerns prompted the USDA to re-evaluate the safety and usefulness of some OTC medications in children. Based on their findings, as of October 2007, the Consumer Healthcare Products Association has withdrawn several OTC cough and cold
medicines from the market for children under 6 yr of age. (listed online at aap.org; “Treating Kids’ Colds Without Drugs” 10/17/2007)
The fact remains that children get sick. We, as parents, want to help them. So what can be safely done?
1. For children < 2yrs, give medications only with the supervision of their health provider.
2. When your child has a cold, encourage them to drink plenty of liquids. A well cleaned humidifier may help with congestion and cough.
3. Be sure you know and understand everything that is in any product you give your child.
4. Use a measuring device meant for medication (ie, not a kitchen spoon).
5. Don’t treat symptoms that aren’t bother your child. If a runny nose does not impair your child’s ability to eat and sleep, ignore it. It will go away with time. The same is true for a cough.
6. Realize that when you use these medications, you are treating the symptoms, but not the cause of the illness. Most colds are self-limited and will go away with time. Infact, some of the symptoms we try to treat can be helpful, such as coughing to keep our airways clear.
7. Call your provider for symptoms that are persistent are seem unusually severe.
aap.org “OTC Medicines”
American Academy of Pediatrics Committee on Drugs “Use of Codeine- and Dextromethorphan-Containing Cough Remedies in Children. Pediatrics Vol 99 No.6 June 1997
FDA Public Health Advisory “Nonprescription Cough and Cold Medicine Use in Children” August 15, 2007