Are Cough Syrups safe for children

below 2 years old?

A lot of parents would have seen the warning "Not recommended for children
below 2 years old" written on the bottles of most cough syrups. However, a lot of
doctors seem to give them out routinely anyway. Here, we aim to clear the air
about this issue.
Below is an example of a WARNING on the Medlineplus site (run by the US
government)
on
a
common
cough
ingredient
"Promethazine"

Promethazine is the active ingredient in the following commonly available

preparations:

What the warning basically means is that if you take any cough preparations
containing promethazine, the chances of your child developing Sleep Apnea is
there.
Not only is this true for promethazine, but it may be a class effect that affects all
drowsy (older generation) antihistamines like Diphenhydramine (Benadryl, Bena
Expectorant), Chlorpheniramine (Piriton) and Dexchlorpheniramine (Polaramine).
(That is why on the bottle/box there will always be the warning of "not
recommended for children below 2 years old").
The reason is that older antihistamines are very lipid soluble (they dissolve better
in oil), making them enter our brain readily. When they enter our brain, these
antihistamines have the potential to interfere with our breathing center, and thus
increases the sleep apnea risk.
Second and third generation antihistamines (Cetirizine, levocetirizine,
fexofenadine, loratadine etc) are less soluble in lipid and thus less readily
penetrate the blood-brain barrier.
So, what do we give to children below 2 when they cough?
Well, if it's not that serious, we give them warm water and NOTHING.

COUGH SYRUPS DO NOT HELP

YOU HEAL FASTER.
A lot of my customers have the notion that if they don't take cough syrup
diligently, their cough will not get better. That is just not true. Cough syrups most
of the time work by suppressing cough, and it may make your life a lot more
comfortable, it does not help you heal any faster.
So what if the cough is NOT that mild, and my baby is below 2?
Well, we agree with the government hospital's practice of giving salbutamol
based cough syrups, as salbutamol will encourage bronchodilation (widening of

the airways) and thus making it easier for your child to breathe. If phlegm is
present/thick, mucolytics like acetylcystein can be added on.
Other herbal preparations like Prospan Syrup are generally safe as they have
been tested in other countries for decades with not much incidents.