A new study shows that if used as prescribed, over-the-counter cough and cold medications are very safe for use in children. But the same study also shows deaths that do occur typically involve children younger than two years of age who received an overdose. The report is published in the Annals of Emergency Medicine.

"Cough and cold products have been sporadically associated with severe toxicity and death in children," writes Dr. Richard C. Dart of the University of Colorado School of Medicine, Aurora and colleagues. In 2005, nearly 65,000 poisonings related to these drugs were reported, including 28 that were serious or fatal.

An expert panel was formed to look at factors contributing fatalities associated with cough or cold remedies involving children younger than 12-years-old.

Of the 178 fatal cases studied, the group concluded that a relationship between the cough and cold ingredient and the fatality was at least possible in 118 cases. Overall, 82 cases involved a non-prescription drug alone, 21 cases involved exposure to both a non-prescription and prescription medication and 15 cases involved only a prescription medication.

The team reported that in the 103 cases that involved non-prescription drugs, ingredients most often mentioned were pseudoephedrine, diphenhydramine and dextromethorphan. Of these cases, 88 were judged to have involved an overdose.

"The intent of the caregivers appears to be therapeutic to relieve symptoms in some cases and nontherapeutic to induce sedation or to facilitate child maltreatment in other cases," the investigators report.

A number of contributing factors were identified, including age younger than two years, use of the medication for sedation, use in a daycare setting or your-babysitter's home, use of two medicines with the same ingredient, failure to use a measuring device, product misidentification and use of a product intended for adults.

"Many of the factors related to inadvertent overdose identified by the expert panel are preventable and interventions could potentially reduce the deaths associated with cough and cold products substantially," Dart's team said.