Over-the-Counter Cold Meds Send Infants to ER

According to the Centers for Disease Control and Prevention (CDC), 1,500 children under the age of 2 years end up in hospital emergency rooms each year after ingesting cough and cold medicines. A recent study by the agency found that the deaths of three babies under the age of 6 months—found dead in their homes in 2005—was caused by these medications. However, despite such statistics, a health advisory issued by the U.S. Food and Drug Administration (FDA) in January and the withdrawal of cough and cold products for children under age 2 from the market, there are still a significant number of small children who are taken to the emergency room after they stop breathing or lose consciousness with over-the-counter cold medications in their systems, according to a new study published in the August issue of Pediatrics.

The study, in which doctors performed toxicology tests on 274 of the 596 children who came to the hospital emergency department between 1997 and 2006 with an apparent life-threatening event found that almost 5 percent of them had cold medications in their urine. The average age of the children was 2.6 months. None of the parents admitted to giving the children medication or taking the products themselves, which could cause the drugs to pass to the child through breast milk. Dr. Raymond Pitetti, associate director of pediatric emergency medicine at Children's Hospital of Pittsburgh and lead author of the study, said while he can't rule out that the symptoms were caused by something else, the ingredients in cold medications can make babies stop breathing. "In that first month of life, their breathing systems aren't very developed yet," Pitetti said. "They're very susceptible to harm, even at very low doses."

According to the American Academy of Pediatrics, cough and cold products such as decongestants, antihistamines, expectorants and cough suppressants can pose serious risks in young children, including convulsions, rapid heart rates, reduced levels of consciousness and even death. In October 2007, an advisory panel to the FDA noted that these products aren't effective in children under age 6 and shouldn't be given to children that age.

Based on his findings, Pitetti is recommending that emergency room doctors routinely perform toxicology tests on any child suffering a life-threatening event. He says that mothers who are breastfeeding shouldn't take cold medications, but if they do, they should refrain from nursing for 24 hours, giving their babies formula or previously pumped breast milk instead. He also suggests keeping a log of all medications in order to prevent accidental overdoses. This can help parents and caregivers avoid giving a second dose too soon, especially if more than one person is caring for the child.

According to HealthDay News, Dr. G. Randall Bond, medical director of the Cincinnati Drug and Poison Information Center at Cincinnati Children's Hospital, said that while "they raised a lot of possibilities (in the study), we don't know if there's a causal relationship." Dr. Bond added, "The question is, what do you do in follow-up?"

Experts have previously suggested that intentional or unintentional poisonings could be responsible for many life-threatening events in children, but the topic has not been systematically studied. Dr. Pitetti's study is the first to provide results of detailed toxicology screenings in infants arriving at the emergency room with life-threatening signs and symptoms.