If used as prescribed, over-the-counter cough and cold medications are very safe for use in children. The deaths that do occur typically involve children younger than 2 years of age who have received an overdose, according to findings reported in the Annals of Emergency Medicine.

“Cough and cold products have been sporadically associated with severe toxicity and death in children,” Dr. Richard C. Dart, of the University of Colorado School of Medicine, Aurora, and colleagues write. In 2005, a total of 64,658 poisonings related to these drugs were reported, including 28 that were serious or fatal.

An expert panel was convened to examine factors contributing fatalities associated with cough or cold remedies involving child younger than 12 years old.

Of 178 fatal cases studied, the panel concluded that a relationship between the cough and cold ingredient and the fatality was at least possible in 118 cases. Overall, 82 cases involved a non-prescription drug alone, 21 cases involved exposure to both a nonprescription and prescription medication, and 15 cases involved only a prescription medication.

The team reports that in the 103 cases that involved non-prescription drugs, ingredients most often mentioned were pseudoephedrine, diphenhydramine, and dextromethorphan. Of these cases, 88 were judged to have involved an overdose.

“The intent of caregivers appears to be therapeutic to relieve symptoms in some cases and nontherapeutic to induce sedation or to facilitate child maltreatment in other cases,” the investigators report.

A number of contributing factors were identified, including age younger than 2 years, use of the medication for sedation, use in a daycare setting or babysitter’s home, use of two medicines with the same ingredient, failure to use a measuring device, product misidentification, and use of a product intended for adults.

“Many of the factors related to inadvertent overdose identified by the expert panel are preventable and interventions could potentially reduce the deaths associated with cough and cold products substantially,” Dart’s team explains.

“A successful public health intervention requires clear identification of contributing factors, implementation of effective tools to address each factor, and ongoing active surveillance to document the effect of interventions and to detect new developments.”

SOURCE: Annals of Emergency Medicine, April 2009.