title: Pediatric fatalities associated with over the counter (nonprescription) cough and cold medications.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO 80204, USA. Rdart@rmpdc.org
authors.forename: Richard C
authors.initials: RC
authors.lastname: Dart
authors.forename: Ian M
authors.initials: IM
authors.lastname: Paul
authors.forename: G Randall
authors.initials: GR
authors.lastname: Bond
authors.forename: David C
authors.initials: DC
authors.lastname: Winston
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Manoguerra
authors.forename: Robert B
authors.initials: RB
authors.lastname: Palmer
authors.forename: Ralph E
authors.initials: RE
authors.lastname: Kauffman
authors.forename: William
authors.initials: W
authors.lastname: Banner
authors.forename: Jody L
authors.initials: JL
authors.lastname: Green
authors.forename: Barry H
authors.initials: BH
authors.lastname: Rumack
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D000996:Antitussive Agents / Q000506:poisoning*; D002648:Child; D002675:Child, Preschool; D003139:Common Cold / Q000188:drug therapy*; D003371:Cough / Q000188:drug therapy*; D062787:Drug Overdose; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D014663:Nasal Decongestants / Q000506:poisoning*; D004366:Nonprescription Drugs / Q000506:poisoning*; D011041:Poisoning / Q000401:mortality*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000996:Antitussive Agents; D014663:Nasal Decongestants; D004366:Nonprescription Drugs