How to pick a cough syrup for children: Pediatricians share safety tips for parents

In the wake of the cough syrup controversy linked to multiple child deaths, pediatricians share top tips to pick cough syrups for children.

Drug safety standards in India are once again under the scanner after several children in Madhya Pradesh and Rajasthan died from consuming contaminated cough syrup. Investigations revealed that the syrups - Coldrif, Respifresh TR, and ReLife — contained dangerously high levels of diethylene glycol (DEG), an industrial chemical known to cause kidney failure. The toxic substance was found at nearly 500 times the permissible limit, triggering nationwide outrage and a crackdown on the manufacturer, whose owner has since been arrested. In response, the government has ordered product recalls, tightened quality checks, and urged parents to avoid over-the-counter cough syrups for children. The controversy has left parents worried and curious about how to pick cough syrups for children.

Which medicine is best for a child's cough?(Adobe Stock)

"Cough is common in children and is often caused by viral infections or environmental triggers. But not every cough needs medication. Knowing when to use a syrup and when to see a doctor is key to keeping your child safe," Dr Rajat Grover - Consultant - Pediatrics and Neonatology at Cloudnine Group of Hospitals, Patparganj, New Delhi (East), tells Health Shots.

Parents should avoid using over-the-counter syrups and consult a doctor if the cough:

• Lasts beyond 5–7 days
• Is accompanied by high fever, breathing difficulty, or chest pain
• Has persistent yellow/green phlegm
• Comes with wheezing, rapid/noisy breathing, or refusal to eat or drink
• Includes blood in sputum or a barking sound

"These may indicate conditions like pneumonia, bronchitis, or asthma, which need medical attention, and not just a cough syrup. No cough syrup should be given without a pediatric consultation," he adds.

How to know which cough syrup to buy?

When buying cough syrups, it is important to know what to look for. Parents should be careful about specific ingredients that can be risky, especially for young children. Here are some ingrediens to avoid, Dr Neeraj Gupta, Consultant Pediatrician at Sir Ganga Ram Hospital, tells Health Shots.

• Terbutaline: "Terbutaline is a bronchodilator used to treat asthma and airway obstruction, relieving symptoms like wheezing and shortness of breath. It can also help prevent premature labour in obstetrics", says the paediatrician.
• Deriphyllin: Deriphyllin is a combination medication for respiratory conditions such as asthma and COPD. It includes a bronchodilator that helps open the airways for easier breathing. Its safety in young children, especially those under six years old, is not well established, so it should be avoided in this age group.
• Codeine: Codeine, an opiate used to relieve pain, cough, and diarrhoea, is often found in prescription medications and some cough syrups. It acts on the central nervous system but can be addictive and may cause side effects like drowsiness, constipation, and nausea.
• Dextromethorphan: “Dextromethorphan is a common cough suppressant found in many syrups. It can help with persistent coughs, but caution is needed, particularly for children,” explains the paediatrician.

These ingredients are not safe for children under six years old and can cause serious side effects. Giving these substances without proper medical supervision can lead to harmful results.

What are the precautions for cough syrup?

One hidden danger in cough syrups, as highlighted by the recent controversy, is the risk of contamination. Dr Gupta warns about diethylene glycol, a harmful substance that is colourless and odourless, making it hard for parents to notice.

To reduce the risk:

• Avoid multidrug combination syrups: These often contain multiple active ingredients that can increase the risk of harmful effects.
• Skip over-the-counter (OTC) medications: “OTC products may not be safe for children, particularly those under six,” warns the doctor.

While parents hope for quick remedies, safety should always come first. Besides, parents should also caution against misuse or overusing syrups.

“Overusing syrups can cause drowsiness and lethargy (due to sedating antihistamines), stomach issues, nausea or vomiting, allergic reactions, as well as increased heart rate or restlessness,” says Dr Grover.

Are all OTC cough syrups safe?

According to Dr Gupta, all over-the-counter cough syrups are not safe for children. Many of these products can cause unexpected side effects. Always check with a paediatrician before buying any medication, even if it is available without a prescription, he asserts.

How to choose the right cough syrup?

Cough syrup packaging can be confusing or unclear. Parents should look for these important things when choosing a product:

• Side effects: Ensure the bottle clearly outlines potential side effects.
• Dosage information: “Labels should detail dosage guidelines suited to your child’s age and weight,” says the expert.
• Certifications: Choose medications from reputed, certified and well-reviewed manufacturers that are certified.

When in doubt, consult your pediatrician for advice on which brands or types of syrup to trust.

How to measure the correct dose of cough syrup?

Self-medicating can cause serious problems. Many parents think they can decide the correct dose for their child based on their age, but Dr Gupta warns against this. She stresses that medical professionals should choose the proper dosage, which can change depending on the child’s age, weight, and overall health.

Is there an alternative to cough syrup?

If you’re unsure about using cough syrups, there are natural remedies that can help. Dr Gupta recommends home-based alternatives:

• Honey (for children over one year): This sweet remedy can soothe sore throats and reduce coughing.
• Warm water gargles: Gargling with warm water can provide relief.
• Steam inhalation: This can help clear nasal passages.
• Proper hydration: Keeping your child well-hydrated is key to recovery.
• Elevating the head: Keeping your child’s head elevated can ease coughs, especially at night.

Talk to a healthcare provider before trying any home remedies. They can help make sure you don’t miss any serious health issues.

(Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always consult your doctor for any questions about a medical condition.)