ABSTRACT. Over-the-counter (OTC) cough and cold medications are marketed widely for relief of common cold symptoms, and yet studies have failed to demonstrate a benefit of these medications for young children. In addition, OTC medications can be associated with significant morbidity and even mortality in both acute overdoses and when administered in correct doses for chronic periods of time. Physicians often do not inquire about OTC medication use, and parents (or other caregivers) often do not perceive OTCs as medications. We present 3 cases of adverse outcomes over a 13-month period-including 1 death-as a result of OTC cough and cold medication use. We explore the toxicities of OTC cough and cold medications, discuss mechanisms of dosing errors, and suggest why physicians should be more vigilant in specifically inquiring about OTCs when evaluating an ill child. Pediatrics 2001;108(3). URL: http://www.pediatrics.org/cgi/content/full/108/3/e52; over-the-counter medications, cough and cold preparations, morbidity, mortality, phenylpropanolamine.ABBREVIATIONS. OTC, over-the-counter; PPA, phenylpropanolamine; ED, emergency department; PICU, pediatric intensive care unit; CBC, complete blood (cell) count; WBC, white blood cell (count); bpm, beats per minute; AAP, American Academy of Pediatrics; CNS, central nervous system; FDA, Food and Drug Administration. C olds, coughs, and upper respiratory infections are common childhood illnesses. The average child suffers from 6 to 10 colds per year, and each cold can last from 10 to 14 days, providing several days and nights of discomfort for the child as well as for his/her caregiver. 1 Many times parents will turn to one of many hundreds of cough and cold preparations for relief. However, over-the-counter (OTC) cough and cold preparations-although generally safe-have no demonstrated benefit. No studies have proven the efficacy of cough and cold preparations in facilitating recovery from these illnesses, 2-6 and most children will eventually improve on their own. However, a small number of children may suffer significant adverse effects from the administration of the very cough and cold formulations they were given in an attempt to relieve their symptoms. For example, the Food and Drug Administration recently issued an advisory to remove phenylpropanolamine (PPA)-a common constituent of OTC decongestants-from those products because of concern for increased risk of hemorrhagic stroke. 7,8 We present 3 cases of children who suffered significant morbidity from OTC cough and cold preparations requiring admission and treatment in a tertiary care hospital during a 13-month period; they ranged from a self-limited reaction requiring an intensive care unit admission to death in 1 patient. Because no cases of death or heart failure attributable to OTC cough and cold preparations have been reported in recent literature, these cases are presented to serve as points for additional discussion on the risks of OTC cough and cold preparations in children. CASE REPORTS Case 1A 36-month-old b...