Cough and cold syrups should be used carefully-Ask Dr. Paul Library

DEAR DR.PAUL: Can I give cough medicine to my son? If so, what brand is best? What is the difference between cough medications that are "DM" and non-DM?

PEDIATRICIAN DR.PAUL ANSWERS: Thanks for your question. It has reminded me that I wanted to talk about "over the counter" (OTC) medications. Just because they are available without prescription, does not mean that these medications have no potential side effects.

As a matter of fact, recent studies have shown that giving cough/cold syrups improperly, or in higher-than-recommended doses can actually be quite dangerous. This applies to all OTC medications of which cold and cough preparations are among the most commonly used. It is important to note that OTC cold and cough preparations are not recommended for children under 6 years of age. In fact, studies have shown them to be ineffective for this age group and to have potentially serious side effects. But before talking about when and how to use such syrups, let me address your second and third questions that apply ONLY TO CHILDREN OLDER THAN 6 YEARS OF AGE:

Generally, all brands contain the following ingredients: DM or "Dextromethorphan" a cough suppressant, "D" which represents a decongestant, and "E", for an expectorant (something that helps bring up chest secretions). These are available in different combinations, and in different forms, ranging from syrup to pill forms:

  • Preparations referred to as "DM", only contain a cough suppressant
  • "DM-D" preparations contain both a cough suppressant and decongestant and
  • "DM-D-E" has all three: a cough suppressant, a decongestant and an expectorant

I usually prefer not to use the combination preparations. Why? Because it does not make sense to give an expectorant, for example, at the same time as a cough suppressant. Bringing up secretions causes a cough reflex allowing us to clear the secretions out. Giving a cough suppressant as well, makes no sense.

When I recommend a syrup for a child with a cold, I usually recommend a DM (cough) preparation, and only if the child is made uncomfortable by the cough - that is, waking up at night or not being able to sleep. For children less than two years old, these preparations should not be used unless under the direction of your doctor.

It is also important to note that if a child has fever, the fever will not respond to these syrups. Only fever medications like Tylenol or Tempra (acetaminophen) can help bring down a fever. Conversely, fever medication cannot help with cold symptoms such as congestion and cough. Another important point to remember is that, in general, cough or cold medications should not be given to children with asthma or other chronic lung problems. If your child is asthmatic, talk to your doctor about what to do during a cold.

Let's not forget the basic treatment of a cold which should include a humidifier (I prefer cold air mists), drinking plenty of fluids, and for younger children, helping wash out the congested nose with a nose pump and saline (salt-water) drops. In most situations, these simple techniques can do the trick, without the use of medications. But if a child requires cough or cold medicines, use them carefully.

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