Check out the latest RANThony on YouTube from Dr. Anthony Crocco on paediatric cough medications. This was recored at the amazing Society of Rural Physicians of Canada (SRPC) Rural and Remote meeting in Banff last week.

We were both invited to the meeting to give the Best of BEEM (BoB) talk. The BoB talk was very well attended and we covered some of the practice changing papers published in the emergency medicine literature in the last few years. SRPC recorded this session and I hope it will be posted soon.

I gave two other talks at SRPC. One was on how to create a rural academic centre of excellence. The other talk was on using social media and FOAMed for rural practice. Dr. Crocco gave an additional lecture on paediatric airway emergencies.

Dr. Crocco is the pediatric lead of the BEEM Dream Team . He is also the Medical Director and Pediatric Emergency Medicine Division Head for McMaster University.

Dr. Crocco is know by the residents to rant on various subjects. Pediatric cough medications is one of his favourite rants. The inspiration for these YouTube videos comes from comedian Rick Mercers who does a rant on his TV show.

SGEM#26: Honey, Honey covered the issue of cough medications for children. It reviewed three publications which Dr. Crocco highlights in his latest RANThony. These included:

Smith et al. Over-the-counter (OTC) medications for acute cough in children and adults in ambulatory settings. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD001831. DOI: 10.1002/14651858.CD001831.pub4.22895922
Oduwole et al. Honey for acute cough in children. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD007094. DOI: 10.1002/14651858.CD007094.pub3.22419319
Cohen et al. Effect of Honey on Nocturnal Cough and Sleep Quality: A Double-blind, Randomized, Placebo-Controlled Study Pediatrics; originally published online August 6, 2012; DOI: 10.1542/peds.2011-3075 cohen-honey-cough

HARM: There are significant dangers to child cough and cold medicine. Data from 2011 National Poison Data System in the USA documented the following for child over the counter cough and cold medicines:

35,000 calls to poison control centres
3% of all pediatric poison control calls
5 pediatric deaths
10% of all pediatric toxicological deaths

Harm Associated with Over-the-Counter Child Cough Medication: In 2011 the Food and Drug Administration (FDA) pulled 500 cough/cold/allergy medicines off the market. The FDA sent a specifically advisory warning that OTC cough medicines should not be used in children under 2 years of age.

“FDA has completed its review of information about the safety of over-the-counter (OTC) cough and cold medicines in infants and children under 2 years of age. FDA is recommending that these drugs not be used to treat infants and children under 2 years of age because serious and potentially life-threatening side effects can occur.”

The American Association of Family Physicians(AAFP) in 2012 recommend that these treatment not be used in children under the age of four.

“In children, there is a potential for harm and no benefits with over-the-counter cough and cold medications; therefore, they should not be used in children younger than four years.”

The bottom line from Dr. Crocco’s review on child cough medication and honey was“If you have a child with a cough older than 1 year of age try a teaspoon of honey every 6 to 8 hours as needed.”

This information is given with the warning that children under the age of one year should not get honey due to the risk of botulism.