Pediatric Fatalities Associated With Over the Counter (Nonprescription) Cough and Cold Medications

Richard C. Dart, Ian Paul, G. Randall Bond, David C. Winston, Anthony S. Manoguerra, Robert B. Palmer, Ralph E. Kauffman, William Banner, Jody L. Green, Barry H. Rumack

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Study objective: The use of nonprescription cough and cold medicines is widespread, but their use has been sporadically associated with severe toxicity and death. We evaluate the role of these medications in pediatric fatalities and identified factors that contributed to the death. Methods: Fatalities that involved a child younger than 12 years and mentioned a cough and cold ingredient were obtained from 5 sources. An independent panel of 8 experts (pediatrics, pediatric critical care, pediatric toxicology, clinical toxicology, forensic toxicology, forensic pathology) used explicit definitions to assess the causal relationship between medication ingestion and death. Contributing factors were identified. Results: Of 189 cases included, 118 were judged possibly, likely, or definitely related to a cough and cold ingredient. Of these 118 cases, 103 involved a nonprescription drug, whereas 15 cases involved a prescription medication alone. Of 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: age younger than 2 years, use of the medication for sedation, use in a daycare setting, use of 2 medicines with the same ingredient, failure to use a measuring device, product misidentification, and use of a nonprescription product intended for adult use. All cases that occurred in a daycare setting involved a child younger than 2 years. Conclusion: In our sample, pediatric fatalities caused by nonprescription cough and cold medications were uncommon, involved overdose, and primarily affected children younger than 2 years. 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.

Original languageEnglish (US)
Pages (from-to)411-417
Number of pages7
JournalAnnals of Emergency Medicine
Volume53
Issue number4
DOIs
StatePublished - Apr 1 2009

Fingerprint

Cough
Pediatrics
Nonprescription Drugs
Toxicology
Forensic Pathology
Forensic Toxicology
Child Abuse
Critical Care
Caregivers
Prescriptions
Eating
Equipment and Supplies
Therapeutics

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

Cite this

Dart, Richard C. ; Paul, Ian ; Bond, G. Randall ; Winston, David C. ; Manoguerra, Anthony S. ; Palmer, Robert B. ; Kauffman, Ralph E. ; Banner, William ; Green, Jody L. ; Rumack, Barry H. / Pediatric Fatalities Associated With Over the Counter (Nonprescription) Cough and Cold Medications. In: Annals of Emergency Medicine. 2009 ; Vol. 53, No. 4. pp. 411-417.
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Dart, RC, Paul, I, Bond, GR, Winston, DC, Manoguerra, AS, Palmer, RB, Kauffman, RE, Banner, W, Green, JL & Rumack, BH 2009, 'Pediatric Fatalities Associated With Over the Counter (Nonprescription) Cough and Cold Medications', Annals of Emergency Medicine, vol. 53, no. 4, pp. 411-417. https://doi.org/10.1016/j.annemergmed.2008.09.015

Pediatric Fatalities Associated With Over the Counter (Nonprescription) Cough and Cold Medications. / Dart, Richard C.; Paul, Ian; Bond, G. Randall; Winston, David C.; Manoguerra, Anthony S.; Palmer, Robert B.; Kauffman, Ralph E.; Banner, William; Green, Jody L.; Rumack, Barry H.

In: Annals of Emergency Medicine, Vol. 53, No. 4, 01.04.2009, p. 411-417.

Research output: Contribution to journalArticle

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AU - Dart, Richard C.

AU - Paul, Ian

AU - Bond, G. Randall

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AU - Manoguerra, Anthony S.

AU - Palmer, Robert B.

AU - Kauffman, Ralph E.

AU - Banner, William

AU - Green, Jody L.

AU - Rumack, Barry H.

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N2 - Study objective: The use of nonprescription cough and cold medicines is widespread, but their use has been sporadically associated with severe toxicity and death. We evaluate the role of these medications in pediatric fatalities and identified factors that contributed to the death. Methods: Fatalities that involved a child younger than 12 years and mentioned a cough and cold ingredient were obtained from 5 sources. An independent panel of 8 experts (pediatrics, pediatric critical care, pediatric toxicology, clinical toxicology, forensic toxicology, forensic pathology) used explicit definitions to assess the causal relationship between medication ingestion and death. Contributing factors were identified. Results: Of 189 cases included, 118 were judged possibly, likely, or definitely related to a cough and cold ingredient. Of these 118 cases, 103 involved a nonprescription drug, whereas 15 cases involved a prescription medication alone. Of 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: age younger than 2 years, use of the medication for sedation, use in a daycare setting, use of 2 medicines with the same ingredient, failure to use a measuring device, product misidentification, and use of a nonprescription product intended for adult use. All cases that occurred in a daycare setting involved a child younger than 2 years. Conclusion: In our sample, pediatric fatalities caused by nonprescription cough and cold medications were uncommon, involved overdose, and primarily affected children younger than 2 years. 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.

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