Children Dying From Cough Syrup? The Shocking Truth Every Indian Parent Must Know

In 2022–2023, contaminated cough syrups from Indian manufacturers caused dozens of deaths in children in The Gambia, Uzbekistan, and other countries. This triggered an international investigation, recalls of numerous Indian-made paediatric cough syrups, and a thorough review of cough medicine safety for children globally. But even before this crisis, the evidence base for cough syrups in children had been deeply problematic for decades.

The Evidence Problem: Do Cough Syrups Work in Children?

Multiple systematic reviews and meta-analyses have concluded that over-the-counter cough and cold medicines provide no clinically meaningful benefit in children under 6 — and the benefits in older children are modest at best. The common cold is caused by viruses; there is no medicine that kills these viruses or significantly shortens the illness duration. What cough medicines do is suppress symptoms — and even this is poorly proven in children.

Dangerous Ingredients to Avoid in Children

Codeine: An opioid — banned for children under 12 in India, the UK, the US, and the EU. Codeine is metabolised to morphine in the liver; in children with a genetic variant (ultra-rapid metabolisers), this conversion is excessive and causes fatal respiratory depression. Several child deaths have been directly attributed to codeine-containing cough syrups. Many Indian cough syrups still contain codeine — read labels carefully.

Promethazine: An antihistamine — specifically contraindicated in children under 2 due to fatal respiratory depression risk. Still found in some Indian paediatric formulations.

Phenylpropanolamine (PPA): Withdrawn globally due to stroke risk — still occasionally found in older formulations in India.

Diethylcarbamazine (DEC): Anti-parasitic, not appropriate for routine cough treatment.

What Actually Helps a Child With a Cough

• Honey (above age 1): A teaspoon of honey at bedtime reduces cough frequency — has actual evidence from randomised controlled trials. Not for infants under 1 (botulism risk)
• Steam inhalation (supervised): Loosens secretions and soothes irritated airways
• Adequate hydration: Warm water, soups, and clear fluids thin mucus and aid clearance
• Elevation of the head during sleep: Reduces post-nasal drip cough
• Saline nasal drops: For nasal congestion contributing to cough

See a doctor if: the cough is accompanied by high fever (above 39°C), rapid breathing, visible chest wall retractions, persistent cough for more than 3 weeks, or any breathing difficulty. These suggest a bacterial infection or other cause needing specific treatment.

Dr. Sushma B at Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.