Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. e318-e322 (doi:10.1542/10.1542/peds.2007-3813)
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ARTICLE

Unexpected Infant Deaths Associated With Use of Cough and Cold Medications

Mary E. Rimsza, MDa and Susan Newberry, MSWb

a Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona
b Arizona Child Fatality Program, Arizona Department of Health Services, Phoenix, Arizona

OBJECTIVE. The objective of this study was to determine whether caregivers had given infants who died unexpectedly over-the-counter cough and cold medications before the infant deaths to identify sociodemographic risk factors for their use.

METHODS. The Arizona Child Fatality Review Program reviews the circumstances surrounding every child death that occurs in the state each year. By statute, the multidisciplinary review teams have access to all medical charts, autopsy reports, law enforcement reports, and other records for their review and use these data to determine the cause of death and its preventability. The data on all infants who died unexpectedly in 2006 and had an autopsy and postmortem toxicologic studies were reviewed for this analysis.

RESULTS. Ten unexpected infant deaths that were associated with cold-medication use were identified. The infants ranged in age from 17 days to 10 months. Postmortem toxicology testing found evidence of recent administration of pseudoephedrine, antihistamine, dextromethorphan, and/or other cold-medication ingredients in these infants. The families who used these medications were poor and publicly insured, and 50% of them had limited English proficiency. Only 4 of these infants had received medical care for their current illness before their death. The over-the-counter cough and cold medication had been prescribed by a clinician for only 1 of these infants.

CONCLUSIONS. Review of these infants' deaths raises concern about the role of the over-the-counter cough and cold medications in these deaths. These findings support the recommendation that such medications not be given to infants. In addition, these findings suggest that warnings on these medications "to consult a clinician" before use are not being followed by parents. Educational campaigns to decrease the use of over-the-counter cough and cold medications in infants need to be increased.

Key Words: over-the-counter medications • cough and cold preparations • unexpected infant death • pseudoephedrine • antihistamine • dextromethorphan

Abbreviations: OTC—over-the-counter • CCM—cough and cold medication • FDA—Food and Drug Administration • ACFRP—Arizona Child Fatality Review Program • CFR—child fatality review

Accepted Apr 4, 2008.


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