Use of OTC Cold Medications in Infants Still High, Warrants Routine Screening

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Title: Use of OTC Cold Medications in Infants Still High, Warrants Routine Screening
URL: http://www.pslgroup.com/dg/226F92.htm
Doctor's Guide
August 4, 2008

NEW YORK -- August 4, 2008 -- Two studies appearing in the August issue of Pediatrics focus on the striking continued use of over-the-counter (OTC) cough and cold medications in children and the dangers of accidental or nonaccidental poisoning caused by these medications.

In the first study, researchers from Boston University's Slone Epidemiology Center, Boston, Massachusetts, found that in the United States, approximately 1 in 10 children uses 1 or more cough and cold medications during a given week.

To define the frequency and patterns of use, the researchers analysed data between 1999 and 2006 from the Slone Survey, a national telephone survey of medication use in a representative sample of the US population. The authors considered all oral medicines that are approved by the FDA to treat children's coughs and colds.

In terms of active ingredients contained in these medications, exposure was highest to decongestants and antihistamines (6.3% each), followed by anticough ingredients (4.1%), and expectorants (1.5%).

Exposures to cough and cold medications were highest among children aged 2 to 5 years and in children aged less than 2 years.

"Given concerns about potential harmful effects and lack of evidence proving that these medications are effective in young children, the fact that 1 in 10 US children is using 1 of these medications is striking," said lead author Louis Vernacchio, MD, Boston University School of Medicine.

In the second study, researchers from the Children's Hospital of Pittsburgh and the University of Pittsburgh, Pittsburgh, Pennsylvania, focused on children presenting to the emergency department with an apparent life-threatening event.

"A number of infants are given cold preparations, either inadvertently through breastfeeding or overtly in a misguided attempt to treat the symptoms of cough and congestion," the authors wrote. "It is even possible that caregivers may give these medications in an attempt to harm the infant."

The authors hypothesised that positive toxicology screen results would result from either intentional or unintentional poisonings, including from the use of OTC cold preparations.

Researchers studied infants aged younger than 2 years presenting to a paediatric emergency department of a large, urban tertiary care children's hospital with signs and symptoms of an apparent life-threatening event.

All of the children presenting with an apparent life-threatening event were to undergo a standardised evaluation, which included obtaining a comprehensive urine toxicology screen.

During the study period, 596 children presented to the emergency department with an apparent life-threatening event, and 274 (46%) had a toxicology screen performed.

Of 274 toxicology screen results, 50 were considered truly positive (18.2%), and 23 of the positive screen results were considered clinically significant (8.4%). Of the positive toxicology screen results, 13 were positive for an OTC cold preparation (4.7%).

The authors recommend that toxicology screens be included as part of the routine evaluation of children who present with an apparent life-threatening event. No parent admitted to having given his or her child an OTC cold preparation.

SOURCE: Boston University and Pediatrics

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