What’s in Cough and Cold Medicines for Children?

Whenever I’m in the over-the-counter (OTC) medication aisle, I see parents confused about what’s best to buy. I sympathize, because I remember reading the same labels before medical school and wondering what might work and what won’t.

Many products combine multiple medications—for example a daytime cough and cold medicine may include a decongestant and a cough suppressant. Nighttime products usually include an antihistamine, a medication more correctly used for allergies, but in this setting, the manufacturer is betting on its sedating properties. Some products labels don’t make much sense: one nighttime cough and cold medicine has a decongestant and an antihistamine but no cough suppressant.

While it’s tempting to throw everything at your child’s symptoms, it’s best to chose the fewest ingredients tailored to your child’s symptoms if you chose to use these products at all. Avoid combination products that include pain and fever medication: you don’t want to double dose these medications because they can damage the liver and kidneys.

The following is a list of ingredients commonly found in OTC medications. Some work well—like the ones for fever and allergies. Others like decongestants, cough suppressants, expectorants and homeopathic treatments have been studied and found lacking. Read more about that here.

Fever and pain medications: also known as antipyretics and analgesics. These include acetaminophen and ibuprophen. Never given aspirin (salicylic acid) to a sick child. It has been associated with Reye’s syndrome, which damages the liver and brain.

Nasal Decongestant: Shrinks swollen, leaking mucus membranes. These medications are in the same class as adrenaline. Side effects include increased heart rate and blood pressure, dry mouth, disturbed sleep, and irritability. They include phenylpropanolamine, pseudoephedrine, ephedrine, and phenylephrine.

Cough Suppressant: also known as an antitussive. The main OTC one is dextromethorphan.

Expectorant: Guaifenesin purportedly thins secretions but evidence is lacking.

Antihistamines

First generation (sedating) antihistamine used to treat allergies, are given every 6-8 hours. Some children reacte to this medication with hyperactivity and excitability. These include diphenhydramine, chlorpheniramine, and brompheniramine.

Second generation (less sedating) antihistamine used to treat allergies, are given once a day. They include cetirizine (Zyrtec) and loratadine (Claritin).

Link to WebMD interview on easing kids’ aches and fevers here.

Link to WebMD interview on keeping sick kids happy here.

Link to CDC report on the complications of over the counter cold medicines in children under 2 years of age here.