Cough and cold medicine at bedtime for a baby or toddler: is it OK?

About the scope of this page: Dr. Sam holds a Doctor of Pharmacy and is a licensed pharmacist, not a physician. What follows is a general explanation of how a medicine, supplement or remedy connects to sleep, and it is no substitute for your child’s pediatrician. Before giving your child any medicine, supplement or remedy, talk to your child’s pediatrician and follow the product label.

The quick answer

When your child is coughing and congested at 10 p.m., everyone suffers, and the medicine aisle can look like the solution. For babies and young toddlers, it is not. These products do not make a cold end sooner, and with combination products it is easy to give the same ingredient twice.

The cold will pass. The sleep that slid during it often does not. That is the part Actually Sleeping helps families with, through a plan written by Dr. Sam, a pharmacist who treats medicine questions seriously and directs medical ones to your pediatrician.

What regulators and the AAP advise

• FDA: advises against over-the-counter cough and cold medicines for children younger than 2. Manufacturers’ labels read “do not use in children under 4 years of age.” The FDA additionally advises against giving homeopathic cough and cold medicine to children younger than 4.
• FDA: cough or cold medicine “will not change the natural course of a cold or make it go away faster.”
• AAP: over-the-counter cough and cold medicine is not recommended for children under 4; between 4 and 6, give it only if your child’s doctor recommends it.
• AAP: plenty of children with a cough or blocked nose stay cheerful, play as usual and sleep well. Treat the symptoms when they cause discomfort or make sleep difficult.

Recommended ways to ease the night

• Saline: plain saline drops or spray loosen mucus; follow with gentle suction for babies. Squeeze the bulb before you put it in the nostril. Suctioning ahead of feeds and sleep helps.
• A cool-mist humidifier close to the sleep space but out of reach, cleaned according to the instructions. The FDA advises against warm-mist humidifiers.
• Fluids throughout the day help thin mucus.
• Honey for children aged 1 year and up. The AAP says research shows honey outperforms store-bought cough syrups at reducing how often and how severely children cough at night. Never give honey to a baby younger than 12 months; the CDC warns it can cause botulism.
• A mentholated chest rub only for children 2 and older, according to the AAP, kept out of reach.

Illness does not change safe sleep

According to the AAP, babies should always sleep flat on their backs on a firm surface, and propping a baby up on towels or pillows or tilting the mattress is unsafe, even when they are congested. Swings, car seats and carriers are not safe places for sleep.

When to get help

• The FDA names a fever of 100.4°F or above in a baby 2 months or younger, or 102°F or above at any age, as reasons to call.
• The AAP says to call 911 if a baby is struggling for every breath or has bluish lips, and to call the doctor if breathing is much faster than usual or coughing keeps your baby from sleeping, eating or playing.

Questions for the pediatrician

• “Is this a cold, or could it be an ear infection, croup or asthma?”
• “Which fever or pain reliever, if any, is right for my child’s age and weight?”
• “Is honey okay for my child, and how much?”

Why sleep stays disrupted once the cold has cleared

A sick child should get comfort without holding back. The catch is that comfort frequently changes the way a child falls asleep: extra feeds, rocking, a spot in a parent’s bed. A week later the child expects the same at every waking, and nights stay disrupted well after the cough has gone. There is more on this in getting sleep back on track after illness.

That pattern can be fixed, and not with medicine. Actually Sleeping writes a plan for your child, provides bootcamp-style coaching before the first night, checks in 1:1 every day and coaches naps until they are solid. Families talk about getting back on track in the client video reviews.

When your child is well again, book the free consultation and get sleep back.