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The CDC has reported three infant deaths during 2005 that were determined by medical examiners to have been caused by cough and cold medications. The infants were all younger than 6 months and had received varying combinations of prescription and over-the-counter (OTC) medications containing pseudoephedrine, carbinoxamine (an antihistamine), acetaminophen, and dextromethorphan. At autopsy, all three infants had blood levels of pseudoephedrine that were 9 to 14 times higher than levels expected in children aged 2 to 12 years who receive appropriate doses.
Centers for Disease Control and Prevention (CDC). Infant deaths associated with cough and cold medications — Two states, 2005. MMWR Morb Mortal Wkly Rep 2007 Jan 12; 56:1-4.
Comment
This report of an avoidable tragedy highlights the need to carefully consider the use of cold medications in infants. Most of these medications have not been studied in children younger than 2 years, and dosing recommendations are not available for this age group. The AAP policy statement (Use of Codeine- and Dextromethorphan-Containing Cough Remedies in Children) concludes that antitussives are not effective in young children and outlines the numerous side effects of sympathomimetic decongestants. I strongly urge pediatricians to spend a few minutes educating families about the risks associated with OTC cold remedies, particularly in children younger than 2 years. The need for anything other than an antipyretic is rare. Asking parents about other OTC medications that they are using at home and being conservative about dosing is critical.