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Following the death of nineteen children in Madhya Pradesh and Rajasthan due to two contaminated cough syrups, the Union Health Ministry has issued an advisory against prescribing or giving cough syrup for cold and cough symptoms in children below 2 years of age.
The alert points to growing concerns over the inappropriate use and safety of these drugs in infants and young children. The health risks are serious – ranging from toxicity to respiratory depression, with experts saying there is little evidence of benefit and incalculable risks for this age group. The ministry has asked states to maintain strict monitoring and safe medical practices for young infants.
“Cough syrups are not safe for babies and can be harmful,” says Dr Akram Syed, pediatrician, Apollo Clinic Bellandur, Bengaluru., They further stated that in infants and young children (under 2 years), the risks almost always outweigh the benefits.
body is not fully developed
In a young child, liver and kidney function are still developing. This means that medications are eliminated more slowly in young children, so there is a greater risk of drug accumulation, overdose, or unexpected side effects.
benefits not proven
Many cough syrups (especially those purchased over the counter) have not had proven efficacy in young children. Often the cough is viral, self-limited, and reducing the cough with medication does not change the course of the disease.
increased risk of side effects
There is a possibility of respiratory depression, drug interaction, and allergic reactions when taking cough syrup. A slight mistake in dosage can have serious consequences.
Risk associated with impurities or poor quality
In recent years there have been cases of fatal poisoning from consumption of cough syrup by children related to contamination (i.e. toxins such as diethylene glycol). Such cases have demonstrated the sensitivity of infants to dangerous situations.
Products that combine drugs in a “cocktail formula”,
Many cough syrups contain 2 or more medications, for example antihistamine, decongestant, and cough suppressant, so for young infants or children, the potential risk increases without proven benefit.
Given all this, it is important to avoid the use of cough syrup in children under 2 years of age, and the only treatment is supportive care (fluids, humidified air, nasal suctioning).
If a child is older than 2 years
When the child is more than 2 years old, things change a bit but still be careful. Here are what one needs to keep in mind:
Always check with your pediatrician first.
Do not give any medicine without permission. The doctor will determine the cause (viral, bacterial, allergy, postnasal drip), and determine whether medication is necessary or it is enough to monitor your child.
Use single-ingredient syrups, not multi-ingredient ones.
Using a single ingredient syrup such as dextromethorphan or a mild expectorant (if indicated) is safer than a “cocktail” that may include a combination of decongestant + antihistamine + cough medicine.
Use dosage according to weight, not “age” or eyeball size.
Most errors come from parents who overestimate their child’s diet. Always ask the pediatrician to specify the mg/kg (or mL) dosage and use the appropriate syringe or measuring cup.
Limit usage period
Use the medication for as short a period as possible (eg: a few days at most). If the cough gets worse or is associated with fever or difficulty breathing, go back to the doctor.
Monitor side effects carefully
Drowsiness, restlessness, changes in breathing, rash or extreme fainting are warning signs. If this happens, stop the medication and seek medical attention.
avoid certain ingredients
Some cough syrups contain decongestants, codeine, and many older antihistamines that are no longer recommended for use in children. Pediatricians should not use these.
Make sure the product is safe and quality assured
Use brands that have appropriate health authority approval, check expiration dates and batch numbers, and don’t use anything that is questionable or too cheap. Manufacturing mistakes have led to tragedies in India.
Use supportive care together
Medicines will not replace measures like rest, fluids, humidification, saline nose drops and warm fluids etc. These will often make the biggest difference.
Beware of risk groups
Tolerance to side effects varies and caution is advised if your child has asthma, any lung disease, heart disease, or is dehydrated or malnourished.
reevaluate frequently
If their symptoms do not improve within 48–72 hours or if the character of the cough changes (increases severity, brings up blood, or causes difficulty breathing), the child should be reevaluated by a pediatrician.
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