Avoid cough suppressants

by Ralph A. Franciosi, MD

Ralph Franciosi, MD, was medical adviser for the Infant Death Center of Wisconsin and pathologist at Children's Hospital of Wisconsin. He also was a professor of Pathology and Laboratory Medicine at the Medical College of Wisconsin.

A SIDS death relates to a combination of three factors - a vulnerable infant, a critical developmental period after birth and environmental triggers/stressors (risk factors).

Our research efforts are directed toward understanding what makes an infant vulnerable and defining the critical developmental window after birth. These studies are very complex and will take years to complete, we encourage a practical approach for reducing risk factors associated with SIDS. One potential risk factor is the use of cough suppressants.

In 1985, A. Kahn, MD, and his colleagues at University Hospital in Belgium wrote an article about the adverse effects of medications containing phenothiazine on infants. The article stated a therapeutic dose can change an infant's sleep characteristics and result in central, obstructive apnea. They recommended central nervous system depressants be avoided in infants under 1 year of age. Apparently in Europe, this medication frequently is prescribed.

The Committee on Drugs of the American Academy of Pediatrics recommended drugs used to suppress a cough be avoided in children, especially infants. Their statement noted numerous over-the-counter cough and cold medications are available and most cough suppressants contain a mixture of dextromethorphan or codeine, antihistamine, decongestant and expectorant in elixirs that contain alcohol. The dextromethorphan and codeine are thought to act directly on the central control of coughing in the brain stem and have the same potential to affect infants' sleep characteristics as central nervous system depressants.

To avoid potential risks, we discourage suppressant cough remedies for infants. In addition, the Back to Sleep campaign also is an attempt to reduce risk factors - prone sleeping and using a soft sleep surface. Other known risk factors are maternal smoking and infant exposure to second hand smoke. Because these risk factors seem to increase the incidence of SIDS, we encourage parents to protect their infants from exposure to the effects of smoking, both before and after birth.

To help avoid potential risks to infants, we will continue to update you on risk factors. Your physician also is a valuable resource.

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