These two 'cough medicines' have been included in the 'blacklist' of drugs, so don't give them to children in a hurry

"Doctor, my baby has been coughing so badly for the past two days. What medicine should I take to get better faster? Do you have any recommendations?"

This is one of the most frequently asked questions by physicians in pediatric clinics.

When a child has a cough, he often cannot eat or sleep well, and parents will find ways to relieve their child's pain. But Xiaojiu wants to remind parents to deal with children's cough and never take medicine indiscriminately!

1. 2 kinds of "cough medicine", do not use it for children

"Drugs are three-point poisonous", especially for children, parents should be more cautious, because children's physical development is not yet mature, and they are more sensitive to drugs. Here are the key reminders of the following 2 cough medicines, never give them to children.

Prohibited drug 1 for children: cough suppressants containing codeine

In 2017, the State Food and Drug Administration (CFDA) issued an announcement clearly stating that codeine drugs are prohibited for children under the age of 12. For children and adolescents ages 12-18, it should only be used if other NSAIDs do not relieve pain. In addition, it should not be used by children and adolescents aged 12-18 with chronic respiratory disease.

In 2018, the State Drug Administration revised the previous announcement, making it clear that codeine-containing cold medicines are prohibited for children under the age of 18 .

Source: CFDA

As early as 2016, the American Academy of Pediatrics (AAP) has called on health care workers and parents to stop using codeine-containing drugs in children because of growing evidence that it may cause life-threatening or serious adverse reactions in children.

Codeine is a natural opioid alkaloid drug. Although it can relieve pain, relieve cough and sedative, its pharmacological effect is similar to that of morphine. Long-term high-dose use is prone to addiction and drug dependence . In addition, the abuse of codeine-containing drugs may also lead to confusion, respiratory depression, and life-threatening.

Pediatric patients, in particular, are at higher risk for respiratory depression and should not be used. In daily life, common codeine-containing drugs include compound licorice tablets, compound licorice mixture, compound licorice oral solution, strong loquat cream, children's diarrhea tablets, and Xiaoke granules, etc. Parents should avoid using them for children.

Prohibited drug 2 for children: cough suppressants containing promethazine

Promethazine has antiemetic and sedative effects and is widely used in cough treatment .

In 2006, the FDA issued a reminder that promethazine hydrochloride injection may cause fatal respiratory depression and should not be used in children under 2 years of age. For pediatric patients 2 years and older, the lowest effective dose is recommended.

There are also relevant recommendations in China, such as: "The Pharmacopoeia of the People's Republic of China - Instructions for Clinical Medication" (2010 edition) records that because promethazine injection has the effect of depressing the respiratory center, it is contraindicated in premature infants and neonates, and children under 2 years old should be used with caution; " According to the Chinese Physician and Pharmacist's Clinical Medication Guide, promethazine has the risk of respiratory depression and even death in children under 2 years old and should be banned.

In short, Xiaojiu recommends parents not to take cough medicines for their children by themselves, and to see the ingredients clearly when taking medicines, and it is best to have the guidance of a professional doctor .

2. How can parents deal with a child's cough correctly?

If the child has a cough, it is not recommended for parents to give the child medicine .

In life, cough is mainly caused by respiratory tract infection and is also a protective reflex of the respiratory tract . If you take cough medicine at every turn and do not solve the underlying problem causing the cough, it may lead to more and more secretions, and even induce bronchitis or pneumonia.

The correct way should be:

① Observe the symptoms of cough and accompanying symptoms.

Dry cough is mainly characterized by no sputum or little sputum, which can be monophonic or paroxysmal; wet cough is mainly characterized by sputum in the throat that is difficult to expectorate, or purulent or bloody sputum with peculiar smell . In addition to coughing, observe whether the child has symptoms such as fever, chest pain, wheezing, hemoptysis, coughing up jam-colored phlegm, vomiting, and difficulty breathing.

②According to the severity of symptoms, decide whether to see a doctor or not

If the symptoms are mild, and the child only coughs during the day, but does not affect eating, drinking, and sleeping, you can continue to observe and do not need to see a doctor for the time being. If any of the following conditions occur, it is recommended to seek medical attention immediately :

Coughing with blood, coughing up yellow-green purulent sputum, hoarse or barking cough, vomiting, with stridor, or bruising;

· Fever, difficulty breathing, affecting eating and sleeping;

No improvement in 2 weeks, or even worsening; or improvement, but cough for more than 4 weeks;

·Age under 4 months.

③ Do a good job of home care to relieve symptoms

You can use a humidifier as appropriate, or give your child a steam bath to keep the respiratory tract moist. If you have frequent coughs at night, you can sleep with the shoulders raised above your shoulders and in a semi-recumbent position, which will help relieve coughing. If necessary, the nasal cavity can be cleaned with saline to remove nasal secretions.

3. Two misunderstandings to be recognized

Some parents like to relieve their children's cough through diet therapy. Xiaojiu reminds that there are 2 misunderstandings to be avoided:

First of all, rock sugar Sydney water can replenish moisture, moisturize the throat, and relieve dry and itchy throats, but there is no evidence that it can " relieve cough and moisten the lungs ". Second, a few studies have found that honey may have some cough relief effect, but for children aged ≤ 1 year, eating honey has a risk of poisoning and should be avoided.

In fact, no matter children or adults, they should be careful when taking cough medicines. It is best to use them under the guidance of a doctor to minimize the risk.

References:

[1] Announcement of the State Drug Administration on Amending the Instructions of the Medicines for Colds Containing Codeine (2018 No. 63), State Drug Administration, 2018-09-06

[2] What kind of medicine is good for my child to take a cold and cough? , Medical Pediatrics Channel, 2019-08-12

[3]AAP: Stop Giving Codeine to Children. Medscape. Troy Brown, RN September 19, 2016

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