Report studies emergency-room visits, deaths among children

NEW YORK The majority of emergency-room visits of pediatrics that were caused by cough/cold medicines were the result of overdosing and occurred primarily in children younger than two years of age, according to a report published in the April 2009 Annals of Emergency Medicine.

“In our sample, pediatric fatalities caused by nonprescription cough and cold medications were uncommon, involved overdose and primarily affected children younger than 2 years,” wrote Richard Dart, author of the report. “The intent of caregivers appears to be therapeutic to relieve symptoms in some cases and nontherapeutic to induce sedation or to facilitate child maltreatment in other cases.”

Researchers investigated 189 emergency-room visits. Of these, 118 were judged possibly, likely or definitely related to a cough and cold ingredient.

Of the 118 cases, 103 involved a nonprescription drug, whereas 15 cases involved a prescription medication alone. Out of the 103 cases associated with nonprescription drugs, the evidence indicated that 88 involved an overdosage. A dosage could not be assessed in the remaining 15 cases.

Several contributing factors were identified, the authors noted. Many of the patients were less than 2-years-old; some of the parents were using the medicines to sedate their child; in some cases, the medicines were administered in a daycare setting; in other cases, there was use of two separate ingredients with the same ingredient; in some instances, parents failed to use a measuring device; and some parents administered a nonprescription product intended for adult use.

“The age group of children younger than 2 years was the most commonly involved,” Dart wrote. “Their small size may facilitate inadvertent administration of an overdose. It is also harder for young children than for older children to communicate emerging adverse effects to their caregiver,” he said. “A potential contributor to the predominance of young children is the fact that the package label of nonprescription cough and cold medications does not provide dosing information for children younger than 2 years.” And hasn’t, incidentally, since late 2007 — the Consumer Healthcare Products Association and its member companies voluntarily withdrew all pediatric medicines labeled “consult your physician” for children under two in favor of “do not use” in children under two.

All cases that occurred in a daycare setting involved a child younger than 2 years, researchers noted.