The Use of Codeine - and Dextromethorphan-Containing Cough Remedies in Children

There is numerous prescription and nonprescription medications currently available for suppression of cough symptoms in children. There is also reported adverse effects and over dosage associated with giving cough and cold preparations to children. Patients and parents need to learn about the "lack" of proven antitussive effects and the potential risks of these products.

What is a cough?

• It is a reflex response to mechanical, chemical, or inflammatory irritation
• The cough is a physiologic function to clear airways of obstructive or irritating material or to warn of noxious substances breathed in from the air.

In diseases such as asthma, bronchopulmonary dysplasia, cystic fibrosis and a variety of inflammatory conditions, excessive and/or abnormal airway secretions may occur. The cough reflex helps maintain airway potency by clearing out these secretions. The clearing of these secretions is essential and may be helped along by chest physiotherapy. Therefore, cough suppression may adversely affect patients with conditions such as asthma, bronchopulmonary dysplasia and cystic fibrosis by creating a build up of secretions, airway obstruction, secondary infection and hypoxemia. In other words, the cough is a necessary function for getting rid of excess secretions in some conditions and should not be suppressed with a cough remedy.

Many of the common respiratory conditions in which a cough is present last only a few days. A cough may also be an expression of airway reactivity or asthma. These types of cough symptoms can be satisfactorily managed with fluids and increased ambient humidity. If a cough continues for many days and is persistent, it is usually due to a secondary infection, allergy (including asthma), environmental irritants (cigarette smoke, dust particles) or a foreign body. The cause of this type of cough should be determined by a health care professional for a long lasting benefit and remedy to the patient.

Antitussive Formulas

Most cough suppressants are mixtures of dextromethorphan or codeine with antihistamines, decongestants, expectorants, and or antipyretics. Some nonprescription cough medicines substitute diphenhydramine or eucalyptus oil in the place of codeine or dextromethorphan. Prescription cough medicines may substitute other narcotic agents such as hydrocodone or hydromorphone for codeine and may be more addictive than codeine. Many of the cough products are also elixirs that contain up to 25% alcohol by volume.

Codeine and dextromethorphan are effective cough suppressants in adults, but similar effectiveness has not been demonstrated in children. Because there are numerous cough and cold preparations readily available over-the-counter, many people think the medications are safe and effective for their children. Studies have shown antitussive preparations given to children is not effective and may even be potentially harmful.

Decongestant (sympathomimetic) components of these mixtures given to children have been associated with:

• Irritability
• Restlessness
• Lethargy
• Hallucination
• Hypertension
• Dystonic reactions

The above reactions may vary with age and disease state.

Why is it possible for these symptoms to occur in children?

• The hepatic enzyme system that metabolizes drugs in young children is relatively immature; therefore, the risk of an adverse effect when using these medicines, especially in infants younger than 6 months is greater.
• When the decongestant mixtures are combined with other drugs such as acetaminophen, the metabolism and/or toxicity may also be changed and cause the child problems.
• In addition, the dosing guidelines for these agents are based on extrapolation from adult data without consideration of a child's potentially unique metabolism and disposition.

Based upon the studies given us at this time, antitussive preparations provide few positive effects when given to children and may even be potentially harmful. Indications for their use in children have not been established.

Suppression of cough reflex in many pulmonary airway diseases may be hazardous and contraindicated. Parents should realize that coughs due to acute viral airway infections are short-lived. Treatment consists of fluids and humidity. If you give your child a cough suppressant during this time you may be inviting more serious problems rather than helping the child get rid of a cough. A cough that last longer than a few days warrants a health care provider evaluation to determine the underlying cause.

Source: American Academy of Pediatrics

Disclaimer: These statements have not been evaluated by the Food and Drug Administration. The information in this article is not intended to diagnose, treat, cure or prevent any disease. All health concerns should be addressed by a qualified health care professional.

This article is FREE to publish with the resource box.

© 2007 Connie Limon All Rights Reserved

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Baby Sun Protection

You may have heard the advice that it's best to keep a baby out of the sun entirely. This can be a challenge, especially with babies that are a little bit older: old enough to protest being covered up by a blanket, but too young to let you know he's getting a sunburn or to move out of the sun into a shady spot. So what's a parent to do? After all, it's important to give your baby outside play time too. So how do you balance the need for fun and exercise with the need to protect your baby's skin? By using the right baby sun protection.

Experts recommend that babies under six months old NEVER be exposed to direct sunlight. There are a number of reasons for this. First, its common sense that baby's skin is more sensitive than an older child's or adult's skin, and therefore more susceptible to sun damage. In fact, a baby's skin is thinner and will burn and sustain long-term UV damage in a much shorter time than children or adults, and once the damage is done it can never be undone. Baby sun protection is important due to the fact that babies have more skin per square inch of body mass than children and adults, so a sunburn would be much more serious (and painful) for a baby. Unfortunately, baby's sensitive skin may not be very tolerant of sunscreen either. In fact, opinion is still divided as to whether it is safe for babies younger than six months to wear sunscreen. Since a baby's thin skin may absorb more of the sunscreen than a child or adult's skin would, and since it was not known what the long-term effects of sunscreen would be, experts once recommended that parents not use sunscreen on babies under six months. More recently, the American Academy of Dermatology and the American Academy of Pediatrics have stated that no adverse effects have been noted from the use of sunscreen on young babies/infants. However, sunburns do pose a significant danger to babies, and so it may be appropriate to use sunscreen on babies younger than six months. However, it is better, if possible, to simply eliminate sun exposure altogether for this age group by using sun protective clothing, sunglasses, hats, blankets, covered strollers, etc.

If you are a parent, you know the challenges that begin when babies become more mobile. While an infant won't object to having a blanket draped over his carrier or car seat an older baby will most certainly balk at this. Experts agree that babies six months and older can and should be covered with a layer of sunscreen on a daily basis, and certainly when they are outside. This way, when blankets fail or baby insists on having the roof removed from his stroller he will be protected from the sun's UV rays. Don't forget to protect baby from the sun during long car rides too. While the car's windows will block some of the sun's UV rays, a few of them do manage to pass through and babies have been known to sustain serious sunburns while riding in car seats, so baby sun protection is vital in the car too.

It's important to be vigilant when baby is in the sun. Sunscreen should not be an excuse for indifference. You wouldn't give your child a lifejacket and then walk away from him while he swims in a lake. Neither should you put sunscreen on a baby and then assume he's protected for the rest of the day. Sunscreen is only one step in the process of UV protection, and should be considered the least effective one. Babies should be dressed in UV protective clothing if possible. This doesn't mean you should be tempted, though, to put long sleeves on your baby in July to protect him from the sun. Babies should always be dressed in a manner that you would dress yourself. If it's 90Ú outside you probably wouldn't put on a sweatshirt, so don't dress baby in one either. Babies are at a greater risk of overheating than adults are, so t-shirts and shorts are best when the temperature soars. Instead, stick to shady areas when outdoors. Putting a wide-brimmed hat on baby will offer more shade when a tree isn't available, and don't forget to protect his eyes with sunglasses. If you do take baby to the park or the pool limit the amount of time he is in direct sunlight to 15 minutes at a time. Then spend 15 minutes in the shade, and take time to examine his skin for signs of sunburn, and reapply sunscreen if necessary.

Dressing your baby in UV protective clothing can greatly decrease his risk of sun damage. Using UV protective clothing will allow him to remain cool in hot weather, while still having an extra layer of sun protection. Be sure you apply sunscreen under the clothing, not just to the parts of his skin that are exposed to sunlight. Sunscreen plus clothing plus hats/sunglasses equal layers of protection that will keep your baby's skin safe, and ultimately protect his health. So make baby sun protection a priority every time you go out, even for short periods of time. It only takes a few extra minutes, and may provide a lifetime of protection for his health.

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