Cough suppressants are ineffective in children

Question Do cough suppressants improve the sleep of childrenwith respiratory infections, or the sleep of their parents?

Synopsis When a young child coughs at night, parents don't getmuch sleep. Although the American Academy of Pediatrics recommendsagainst antitussives because of their lack of demonstrated benefit,these products fly off pharmacy shelves in the winter months.This randomised controlled trial (double blinded) identified100 children experiencing rhinitis and cough symptoms for oneweek or less who didn't have asthma or allergies; in other words,children with a cold. The average age was slightly over 4 years(range 2-16 years). The children were randomised (allocationconcealment uncertain) to receive a single dose of placebo,diphenhydramine (Diphen), or dextromethorphan (Benylin) forthe single night of the study. Using a seven point Likert scale,parents were asked to rate the effect of treatment on the child'scough frequency, as well as the effect on their own sleep andthat of the child. As compared with ratings obtained for thenight before the study night, parents overall reported a significantdecrease in cough frequency and severity (from "somewhat" to"occasional" on the descriptive scale). The combined symptomscore decreased from 19.8 to 8.9 (of a possible 30) with anytreatment (P < 0.01). Parents also reported a significantimprovement in both their sleep and their children's sleep.However, the results were not different whether the child wastreated with either drug or placebo. Adverse effects were reportedequally in all three study groups. The study had the power tofind a one point change in scores of the three arms, if onetruly existed.

Bottom line In this single dose study, placebo worked just aswell as either dextromethorphan or diphenhydramine to decreasefrequency or severity of cough in children. Also, the activedrugs provided no additional benefit on parents' report of theirown or their child's sleep. This is both bad news and good news.The bad news is that these drugs don't work any better thanplacebo (which, actually, was reported to work pretty well).The good news is that when parents feel the need to do somethingwhen their child has a cold, all products work equally well.

Level of evidence 1b (see Individualisedrandomised controlled trials (with a wide confidence interval).

Paul IM, Yoder KE, Crowell KR, et al. Effect of dextromethorphan,diphenhydramine, and placebo on nocturnal cough and sleep qualityfor coughing children and their parents. Pediatrics 2004;114:e85-90 [Abstract/Free Full Text].

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