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.


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.

And there you have it. For any questions, please let us know via our facebook page.