#tipsfornewpeds: children’s aisle and cough

Every time I go into the children’s section of a pharmacy there seem to be new remedies that I have heard nothing about. It’s particularly embarrassing to be asked about a product, have no clue what it is, and then find that it is plastered all over the local Whole Foods baby section. Here is a primer on one of the most common types of baby products that come up, cough medicine.

Before starting, I will say that parents buy these when they have kids that are sick, uncomfortable, can’t sleep, and generally miserable. Everyone is miserable that is. Young kids up all night coughing is terrible, only narrowly beaten out by up all night vomiting. Parents get to the point of wanting to try anything that might help. I find, if you avoid the “don’t ever even look in this aisle” approach and provide information to help parents make their own decision, more often than not they will steer away from unproven treatments.

In most baby aisles, you won’t find medications with dextromethorphan, guaifenesin, or antihistamines – which is good, since in children we don’t recommend them (a topic for self -study) and most have significant side effects with real harm, especially codeine (Rx, I know) containing products or products that mix acetaminophen with other medications (overdose risk). What you will find is many honey and agave based products, Zarbee’s being one of the most popular. Agave is marketed as the alternative to honey for kids under 1 year.

Honey does have some small place in treatment of cough. A Cochrane review from 2018 gave the ringing endorsement that honey (remember over 12 months) “probably relieves cough symptoms to a greater extent than no treatment.” Though they point to no strong evidence to support or refute the use of honey. Sweet.

Sadly, agave does not have quite the same track record, as Paul et. al. demonstrated in this 2014 JAMA peds paper. They concluded there was no additional benefit to agave over placebo in a randomized trial of 120 children.

A really important thing to remember is that all of these herbal and honey based products are not regulated by the FDA, they are considered supplements! See here for a overview from the American Cancer Society on the difference. This has serious implications for the safety of these products in general and I find many parents are unaware of this fact.

Lastly there are several rubs or salves marketed for cough. Vicks is the most common and only one with some good evidence behind, with several other, non-champhor / menthol based products out there.

For an overview, check out this post from Seattle Mama Doc, Dr. Wendy Sue Swanson (@SeattleMamaDoc, hightly recommended follow!). It references a Pediatrics paper that is a bit old (2010) but is still one of my favorites to cite in clinic as they blinded parents by having them put Vicks under their own noses.

The caveat with these potentially irritating products is there is concern that they can worsen respiratory distress by causing increased mucus production and can be toxic if ingested or rubbed in eyes. I don’t recommend for younger kids and am cautious with any child with a history of asthma or eczema.

Good luck, we still have a couple more months before cold season winds up again, hope you have a couple extra tools in your pocket for helping families this fall.

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