Should I Give My Child Cough Syrup?

untitledWith the cold and flu season upon us many people come into the clinic with their children because, well, kids cough. No surprises there. I tell parents at least 20 times a day (no joke) about cough syrup. I understand that many parents are what we call “well worry” parents and they want their children to be healthy and happy. Nothing wrong with that. What kills me though is that so many people think drugs are going to be the answer. Some parents will come back and see another doctor to get something if the first one doesn’t prescribe.



The feeling I get when someone is convinced that the only way to get better is to get medication that has been proven not to be better than placebo.

I think we should probably go over the obvious. Antibiotics don’t do anything to take care of a cough…unless that cough is due to a BACTERIAL infection. Some common signs of bacterial infection include, but aren’t limited to; fever, congestion, thick colored mucus, cough, earache, headache and generally feeling like crap. And these are just for upper respiratory infections.

VIRAL upper respiratory infections can include but aren’t limited to; congestion, thick mucus, cough, headache, earache and generally feeling like crap. Notice how viral infections like a common cold and bacterial infections look similar? That’s because they are, at least in their presentation.

Kids have a hard time and it is no fun for any parent to see their little tykes go through a cold. Draining down the back of the throat at night can cause the throat to become red and irritated and sore. Coughing usually ensues. No bueno.

This is where cough syrups supposedly come into help save the day. Guaifenesin is common and so is dextromethorphan. The two are often combined. You’ll see this as Robitussin DM or Q-Tussin DM. Guaifenesin basically hydrates mucus more so that people can expell it easier and dextromethorphan works in the brain to slow down and stop the coughing reflex.

For people that have this draining issue neither medication works particularly well. The mucus is already thin and the coughing comes from trying to expel it.

I’m not saying these two meds don’t have a place in therapy, but it’s probably not nearly as often as you might think. Heck the FDA doesn’t even recommend them in kids under 2 because they really don’t do anything and there’s the potential for problems.

One study looked at honey vs placebo and found that honey actually relieves cough better than placebo. [1] The funny thing was that placebo actually helped cough too.

A study just came out that looked at the efficacy of agave nectar vs placebo in children with cough. Agave nectar also gave relief to children. [2]

If you’re planning on giving you’re child honey for cough and they aren’t 12 months old, please don’t. Although the risk is low, there is a chance of botulism poisoining with infants ingesting honey and that is far worse than any cough they will have.

If you’re not sure and still want to give your kids diphenhydramine or dextromethorphan, a study from Duke showed that those faired no better than placebo. [3] In fact dextromethorphan actually caused more insomnia so less sleeping and still the chance of coughing.

For anyone interested in the agave nectar the doses were as follows:

3 mL for ages 2 to 5 months

4 mL for ages 6 to 23 months

5 mL for ages 24 to 47 months

The honey dose was about 7.4ml or 10gm.

If you’re kids are having some cough or you yourself are experiencing issues give some agave nectar or honey a try. I prefer honey in some ginger tea. It works great to fight off the beginnings of a cold. Just staying hydrated will also help.



1.Cohen, Herman Avner, et al. “Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study.” Pediatrics 130.3 (2012): 465-471.

2. Placebo effect in the treatment of acute cough in infants and toddlers, Ian M. Paul, et al., JAMA Pediatr, doi:10.1001/jamapediatrics.2014.1609, published online 27 October 2014.

3.Paul, Ian M., et al. “Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents.” Pediatrics 114.1 (2004): e85-e90.


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