Over-the-counter cough and cold medications in children: bridging the gap between evidence and clinical practice

ABSTRACT

Over-the-counter cough and cold medications are widely used in children despite insufficient evidence of efficacy and well-documented safety concerns. This narrative review summarizes current evidence on pharmacological and non-pharmacological treatments for both acute and chronic cough in pediatric populations. Most over-the-counter medications, including antitussives, antihistamines, expectorants, and mucolytics, have not demonstrated superiority over placebo. In contrast, selected non-pharmacological interventions, such as honey and vapor rub, may provide modest symptomatic relief in specific age groups.

In chronic wet cough, cough suppression may be inappropriate, as it can delay the diagnosis and treatment of underlying conditions such as protracted bacterial bronchitis and bronchiectasis. Management should therefore prioritize etiological evaluation, caregiver education, and evidence-based interventions.

IMPACT STATEMENT

Over-the-counter cough medications in children lack consistent evidence of efficacy, with most pharmacologic agents performing no better than placebo while exposing children to potentially significant adverse effects. Chronic wet cough should not be suppressed, as it may represent an important clinical marker of underlying airway disease. At present, honey remains the only consistently supported symptomatic therapy for acute cough in children older than one year.

KEY WORDS

Pediatric cough; OTC medicines; antitussives; honey; herbal medications.