At least five states have banned the sale and distribution of Coldrif cough syrup after the deaths of at least 19 children in Madhya Pradesh were allegedly linked to the medicine. A laboratory test in Chennai found that the syrup contained 48.6 percent diethylene glycol, a toxic chemical used as an industrial solvent.
Rajasthan has also banned cough syrups containing dextromethorphan after three children died there last week. These cases have sparked widespread fear among parents about whether cough syrups are safe for children at all. Doctors say most cough syrups are not dangerous if used correctly, but contamination and misuse remain serious risks.
Are cough syrups dangerous for children?
Doctors explain that cough syrups available in pharmacies usually contain dextromethorphan hydrobromide, a suppressant that blocks the cough reflex in the brain. “It is not a nephrotoxic drug and cannot cause kidney failure on its own,” said Prof Pankaj Hari, head of paediatrics at the All India Institute of Medical Sciences (AIIMS), New Delhi.
The recent deaths were linked to adulteration with diethylene glycol, a poisonous solvent. “This is what damages the kidneys and leads to fatalities,” Prof Hari said. He added that parents must buy syrups only from recognised companies and avoid unlabelled or suspicious brands.
While cough syrups themselves are not inherently fatal, doctors stress that they should not be given to children under the age of four, except in rare cases under medical supervision. In the United States, the practice is to avoid cough syrups for children under six, and India follows similar guidelines for infants and toddlers.
When should children be given cough syrups?
Not all coughs need medicine. Dr Shivani Parikshak, a paediatrician at Franciscan Physician Network in Greenwood, said most coughs in children are caused by viral infections such as influenza, RSV. “If the cough isn’t bothering the child, they likely don’t need any medication,” she said. “Most kids remain playful and sleep well despite the cough.”
Doctors distinguish between two main types of syrups. Suppressants are used for dry coughs, while decongestants help clear nasal blockages that can trigger cough. Both should only be given after consulting a paediatrician.
What is the right dosage for children?
Dosage is a critical issue. Cough syrups are often sold over the counter in India, and families sometimes buy them without a prescription. Prof Hari warns against this practice. “A general physician may not be aware of the dosage that paediatricians use. Always get a prescription from a child specialist,” he said.
Dosage is calculated in milligrams per kilogram of body weight. Typically, doctors prescribe 0.5 to 1 milligram per kilogram, not exceeding three doses per day. Parents must always use the dosing cup or syringe provided with the medicine. Household spoons are inaccurate and can lead to overdosing.
If a doctor prescribes cough syrup for a child under four, the prescription must clearly mention the exact dosage.
What are the side effects of overdosing?
Taking too much cough syrup can lead to sedation, drowsiness, rapid heartbeat, nausea, and vomiting. In adolescents, large doses can cause a “drug high” and may lead to misuse or addiction.
Dr Parikshak warned that overdosing can be life-threatening. “Side effects can include slowed breathing, hallucinations, seizures, and in severe cases, coma or death,” she said. Parents are advised to call the Poison Control Centre at 1-800-222-1222 immediately if they suspect an overdose.
What should parents check before buying syrups?
Pharmacologists advise checking several details before purchase:
Manufacturer details and batch number must be clearly listed.
Manufacturing and expiry dates should be visible.
The product should contain propylene glycol as a solvent, not diethylene glycol or ethylene glycol.
A drug license number from state authorities must be printed on the bottle.
WHO-GMP or ISO certification marks should be present.
Parents should buy syrups only from licensed pharmacies and avoid unlabelled bottles, open packs, or products from unknown sources. Some brands now carry QR codes linking to batch test reports; if the code fails, experts recommend avoiding the product.
Alternatives to cough syrups
Doctors say pharmaceutical options for infants are limited. For children under two, syrups are best avoided. Safe alternatives include home remedies such as saline nasal drops, steam inhalation, humidified air, or honey for children over one year.
Dr Parikshak recommends simple steps. “Honey can help coat the throat and reduce irritation. Saline sprays and cool-mist humidifiers are safe and effective for congestion,” she said. She also suggests chest rubs for older children to help them sleep better.
Rest and hydration remain essential. “Fluids soothe the throat and prevent dehydration,” she added.
When to see a doctor
Parents should consult a doctor if a child has difficulty breathing, wheezing, or blue lips. A fever above 102°F, persistent ear pain, or refusal to eat and drink are also warning signs.
“Coughs often linger for two to four weeks after a viral illness, which can be normal,” Dr Parikshak said. “But if the cough suddenly worsens, or lasts longer than expected, it could signal a secondary infection.”
Asthma patients also need special attention. A sudden increase in coughing could mean the condition is worsening, not just a viral infection.
Why the recent panic?
The bans on Coldrif and other syrups highlight a regulatory gap. While standard brands are usually safe, contamination with toxic chemicals has caused repeated tragedies in India and abroad.
The U.S. Food and Drug Administration and India’s Central Drugs Standard Control Organisation both caution against using over-the-counter cough syrups for young children. “Over-the-counter medicines are not recommended for babies and young children under four,” Prof Hari said. “Parents must remember that most coughs are self-limiting and do not require medicine at all.”
What parents need to remember
Most coughs in children improve without medication. Safe remedies like saline sprays, steam, and honey often work better than syrups. Cough syrups should never be bought without a doctor’s advice, and dosage must be carefully measured. Parents should also check labels for solvents, certification, and expiry dates before giving any syrup to a child.
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