*This post originally appeared on The PediaBlog on January 18, 2018.


No Opioid Rx For Coughs


Other than a nice warm bowl of chicken soup or a spoonful of honey (for children older than one year of age), parents will find that the numerous over-the-counter products marketed to treat symptoms of colds and flu are expensive, ineffective, and have unintended adverse consequences. As we mentioned yesterday when we considered over-the-counter treatments for symptoms of influenza, it is unlikely your pediatrician will recommend those cold “remedies” for your children. Besides, Maggie Fox says, they just aren’t necessary:

Pediatricians have mixed feelings about cough and cold remedies for kids in general. The FDA advises against giving any over-the-counter cold, flu and cough remedies to children under 2, and the Infectious Diseases Society of America says don’t give them to children under 4. The FDA persuaded drug companies to voluntarily take over-the-counter cough and cold drugs for infants off the market in 2007…

The FDA will remind parents that most coughs and colds don’t need any treatment at all. Most upper respiratory infections are caused by viruses, and with the exception of influenza, there aren’t any drugs that work against viral respiratory infections.


There are prescription medications that can be prescribed, especially to suppress a persistent cough during a prolonged cold or as part of the flu. Most of these medicines contain codeine or hydrocodone, which are opioid drugs that the American Academy of Pediatrics and, in a new warning, the U.S. Food and Drug Administration (FDA), advise against giving to children. The urgency for such a warning comes as the nation combats a horrible opioid crisis, reports Melissa Jenco:

“Given the epidemic of opioid addiction, we’re concerned about unnecessary exposure to opioids, especially in young children,” FDA Commissioner Scott Gottlieb, M.D., said in a news release. “We know that any exposure to opioid drugs can lead to future addiction. It’s become clear that the use of prescription, opioid-containing medicines to treat cough and cold in children comes with serious risks that don’t justify their use in this vulnerable population.”

In addition to addiction, codeine and hydrocodone have been linked to difficulty breathing, overdose and death. Last year, the FDA announced codeine is contraindicated to treat pain or cough in children under 12 years. Experts including its Pediatric Advisory Committee have continued to study the issue, leading the FDA to expand its previous warning.

Labels now will indicate these drugs should be used only in adults over 18 years and will include an expanded Boxed Warning detailing the risks.


Since pediatric primary care providers and specialists rarely, if ever, prescribe opioids to treat coughs (and their use for treating pain is also on the decline), the temptation might be for parents to administer a dose of opioid-containing medication, prescribed for them by their own adult doctor, to their sick child. That temptation can be eliminated by appropriately discarding all medications that contain opioids, including codeine and hydrocodone, from the medicine cabinet. The risks to children and adults posed by these pharmaceutical products are just too great.


(Google Images)