Dr. Jyothi Raghuram Senior Consultant – General Pediatrics & Pediatric Rheumatology

Jyothi Raghuram博士 高级顾问 – 普通儿科与儿科风湿病学

For many years, whenever parents had a child with a cough, it was reflex to offer them a spoon of cough syrup.  That is quickly changing. Throughout India, there has been a noticeable shift in the approach doctors take to prescribing cough syrups to children due to safety concerns and updated guidance..

多年来，每当父母的孩子咳嗽时，给他们一勺止咳糖浆似乎是理所当然的做法。但现在这种情况正在迅速改变。由于安全问题和更新的指导方针，印度各地医生在给儿童开止咳糖浆方面的做法已经有了明显的转变。

A Wake-Up Call from Recent Events

近期事件的警钟

Recent incidents of children dying after consuming contaminated cough syrups have opened the discussion about safety once again. Investigators found harmful substances in unacceptable amounts which demonstrated a failure of quality control in medicines. The loss of these children led to regulators imposing more oversight of cough syrups and some states mandating a script before purchase, especially for infants and young children..

最近，儿童在服用受污染的止咳糖浆后死亡的事件再次引发了对安全问题的讨论。调查人员发现这些药物中存在过量有害物质，显示出药品质量控制的失败。这些儿童的死亡促使监管机构加强对止咳糖浆的监督，并有一些州要求购买前必须凭处方，特别是针对婴儿和幼儿。

In addition, the Union Health Ministry sent advisories to doctors requesting rational prescribing for cough syrups in children for true medical need and reminding states that most coughs are self-limiting, even if viral. This increased scrutiny has shaped expectations of pediatricians for one of the most common symptom complexes in children..

此外，联邦卫生部向医生发送了建议，要求为儿童开具咳嗽糖浆处方时需基于真实的医疗需求，并提醒各州大多数咳嗽即使是由病毒引起的，也是自限性的。这种加强的审查塑造了儿科医生对儿童最常见的症状群之一的期望。

Why Doctors Are Rethinking Cough Syrups

为什么医生在重新考虑咳嗽糖浆

Paediatric coughs are most often caused by

儿科咳嗽最常见的原因是

viral infections

病毒感染

, which typically improve within 7–10 days without the need for medication.

通常在7到10天内无需药物即可改善。

Cough syrups do

咳嗽糖浆确实有效。

not treat the underlying infection

不治疗潜在的感染

; they only temporarily suppress symptoms.

；它们只能暂时抑制症状。

Some ingredients can cause

某些成分可能会导致

side effects

副作用

such as drowsiness, vomiting, or, in rare cases, breathing problems — especially in children under 2 years.

例如嗜睡、呕吐，或在极少数情况下出现呼吸问题——尤其是在2岁以下的儿童中。

Overuse or combining multiple cold medications increases the risk of

过量使用或混合多种感冒药会增加风险

accidental overdosing

意外过量服用

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。

Due to these considerations the national and international guidance now recommends against routinely using cough syrups in young children. The Central Drugs Standard Control Organization (CDSCO) and the expert consensus statement clearly indicate that fixed-dose combinations should be avoided in children under 4 years of age, and recommended physician discretion in deciding to use fixed-dose combinations..

基于这些考虑，国家和国际指南现在建议不要在幼儿中常规使用止咳糖浆。中央药品标准控制组织 (CDSCO) 和专家共识声明明确指出，4 岁以下儿童应避免使用复方制剂，并建议医生在决定使用复方制剂时谨慎判断。

When Doctors Avoid Cough Syrups

当医生回避止咳糖浆时

As pediatricians, there are certain situations where we will clearly choose not to prescribe cough syrups:

作为儿科医生，有些情况下我们显然会选择不开止咳糖浆：

In children less than or equal to 2 years old, the risk outweighs the benefit.

在小于或等于 2 岁的儿童中，风险大于益处。

In mild dry, short coughs due to viral infections, where patients are improving.

在因病毒感染引起的轻度干燥、短暂咳嗽的情况下，患者正在好转。

In nighttime coughs from nasal drip or allergies, home remedies are actually more helpful.

夜间因鼻涕倒流或过敏引发的咳嗽，家庭疗法实际上更有帮助。

We rely on supportive care in these conditions, which provides patients with equal or greater relief compared to medication.

在这种情况下，我们依靠支持性护理，这能为患者提供与药物相当或更大的缓解。

When Cough Syrups Are Considered

当考虑止咳糖浆时

There are specific instances where cough syrups can help — but these are the exception, not the rule.

有些特定情况下，咳嗽糖浆可能会有帮助——但这些是例外，而不是常规。

Ongoing coughs that dry out the lungs and interrupt sleep after serious causes are excluded.

排除严重原因后，持续的咳嗽会使肺部干燥并影响睡眠。

Coughs associated with allergies or asthma when cough medications exist to treat. It must be emphasized here that inhaled medications are the first choice in children with asthma, both for relief of acute episode and to prevent recurrence of symptoms.

与过敏或哮喘相关的咳嗽，当有止咳药可以治疗时，必须在此强调，吸入性药物是哮喘儿童的首选治疗方式，既能缓解急性发作，又能预防症状复发。

If cough is due to a bacterial infection antibiotics are the primary intervention and cough syrup maybe given in addition for short duration to relieve symptoms.

如果咳嗽是由细菌感染引起的，抗生素是主要的治疗手段，此外还可以短期使用止咳糖浆来缓解症状。

Coughs that are “wet” but have thick secretions where an expectorant may help clear thick secretions.

湿咳，但分泌物粘稠，祛痰剂可能有助于清除粘稠的分泌物。

Even in situations as these, the dosing is always calculated and provided based on the child’s age, weight and the parents are counseled on how long to give the cough medication and not to self-medicate if another episode occurs as each time the cause maybe different.

即使在这些情况下，剂量也始终根据孩子的年龄、体重来计算和提供，并且会告知父母给咳嗽药的时间，如果再次发作不要自行用药，因为每次的原因可能不同。

The Doctor’s Checklist

医生的检查清单

Before prescribing anything, we assess:

在开任何处方之前，我们会评估：

Age and weight of the child

儿童的年龄和体重

Type and duration of cough

咳嗽的类型和持续时间

Associated symptoms like fever, breathlessness, or chest pain

伴随症状，如发烧、呼吸急促或胸痛

Underlying conditions such as asthma or allergies

哮喘或过敏等潜在疾病

Risk factors for complications

并发症的风险因素

This helps us determine whether medication is necessary or whether watchful waiting and home care are safer options

这有助于我们确定是否需要用药，或者观察等待和家庭护理是否是更安全的选择。

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。

What Parents Can Do at Home

父母在家里可以做什么

The involvement of parents is very important for recovery. Here are measures that are safe and effective:

家长的参与对康复非常重要。以下是一些安全有效的措施：

Encourage your child to drinkmore fluids during illness. Warm fluids are good for hydration.

鼓励您的孩子在生病期间多喝 fluids。温暖的液体有助于补充水分。

Saline nasal drops are helpful for examining nasal congestion during recovery.

生理盐水滴鼻液有助于在恢复期间检查鼻塞情况。

Steam inhalation or humidified air is helpful for recovery.

吸入蒸汽或湿润的空气有助于恢复。

Honey can be soothing to the throat (during recovery and if your child is older than 1 year of age).

蜂蜜可以舒缓喉咙（在恢复期间，如果你的孩子超过一岁）。

Avoid asking your friendly neighborhood pharmacist for over-the-counter cough syrups for your child.

避免向你附近友好的药剂师询问非处方止咳糖浆给孩子使用。

If your child has a persistently high temperature, fever, has difficulty breathing, blue lips, refusal to feed, consult your Pediatrician immediately.  If the cough lasts more than a week or is recurring frequently

如果您的孩子的体温持续偏高、发烧、呼吸困难、嘴唇发紫、拒绝进食，请立即咨询您的儿科医生。如果咳嗽持续超过一周或频繁复发，也要及时就医。

The Bottom Line

底线

Cough syrups are no longer prescribed automatically — and for good reason. Between safety concerns, limited effectiveness, and updated guidelines, paediatricians now approach each case with

止咳糖浆不再被自动开处方——而且有充分的理由。在安全问题、有限的效果和更新的指南之间，儿科医生现在会针对每个病例采取不同的方法。

greater clinical caution

更大的临床谨慎

. For parents, this means trusting the process, avoiding self-medication, and recognising that

对于父母来说，这意味着信任这个过程，避免自我治疗，并认识到

most childhood coughs don’t need a bottle of syrup — just time, care, and patience

大多数儿童咳嗽不需要一瓶糖浆——只需要时间、关心和耐心。

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