Society for 
Physician Assistants
in Pediatrics 

News

  • 11 May 2017 12:44 PM | Monique Ochoa (Administrator)

    FDA Expert Roundtable Meeting on the

    Use of Cough Suppressants in Children

    I was recently privileged to serve as the PA representative on a Food and Drug Administration roundtable to discuss the use of cough suppressants in children, with particular attention to opioid containing antitussives.  In addition to the AAPA and SPAP, there were representatives from many organizations including the American Academy of Pediatrics, American Thoracic Society, American College of Chest Physicians, National Association of Pediatric Nurse Practitioners, and American College of Emergency Medicine.

    The FDA was seeking current practice and treatment guidelines from clinicians surrounding the use of cough suppressants in children.  There have been a number of studies looking at the use of over-the-counter and prescription cough and cold formulations in the pediatric population revealing limited evidence regarding the efficacy of these drugs.1,2  There has also been some concern regarding the safety of these drugs.1  Both the American Academy of Pediatrics and the American College of Chest Physicians have advised against the use of cough and cold medications in young children under the age of 4 years.3,4

    In response to a growing epidemic of opioid abuse, the FDA was further seeking current practice to reassess its approach to opioid medications in general.  There are known safety issues with the use of codeine in children particularly respiratory depression.5  There is further limited evidence on the efficacy of codeine for cough suppression.6

    The panel was overwhelmingly against the use of codeine in children, especially those under the age of 12 years, or in any child with a chronic respiratory disorder, i.e. asthma, cystic fibrosis.  It was even suggested by the panel that the opioid containing antitussives simply be removed from the market.  There was a lot of discussion about the role and value of suppressing a cough in children.  Consensus was that there are very rare instances where there is any need to suppress a cough.  The focus on treating a cough should be aimed at the underlying etiology and using bronchodilators, steroids, antibiotics, or other medications appropriately to treat that cause. 

    It was recognized that in the primary care setting, and frequently in the emergency room or urgent care settings, that parents and caregivers want something to treat the cough.  Health Care Providers would need to focus on educating families on the ineffectiveness of cough suppressants, and the frequently self-limited nature of the cough especially in viral upper respiratory infections.  Honey was cited as a safer alternative for treating cough.7

    The AAP released a clinical report in October 16 calling for a contraindication for the use of codeine in children for pain or for treatment of cough.5  Most recently, in April 2017, the FDA revised its restriction on the use of codeine to a contraindication to using codeine to treat pain or cough in children under the age of 12 years.  The FDA went further by issuing a warning against using codeine between the ages of 12 and 18 years in patients who are obese or have conditions such as obstructive sleep apnea or lung disease.8

    Cough is the most common chief complaint in the United States and carries a large burden in time and treatment costs.9  Unfortunately, in children there are no existing effective treatments for cough other than those aimed at treating the underlying cause.  The value of cough suppression itself is questionable.  Opioid containing antitussive medications should not be used to treat cough especially in pre-adolescence or in the presence of obesity, OSA, or lung disease.

    • 1.       Carr, B. Efficacy, abuse, and toxicity of over-the-counter cough and cold medicines in the pediatric population. Current Opinion in Pediatrics. 2006, 18:184-188.
    • 2.       Smith, SM, et al.  Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database Syst Rev. Nov 2014, (11).
    • 3.       Lowry, J. Leeder, J. Over-the-counter Medications : Update on Cough and Cold Preparations.  Pediatrics in Review. July 2015, 36(7).
    • 4.       Chang, A; et al.  Guidelines for Evaluating Chronic Cough in Pediatrics.  Chest. Jan 2006, 129:1(suppl).
    • 5.       Tobias, J; et al.  Codeine: Time to Say “No”. Pediatrics. Oct 2016, 138(4).
    • 6.       Gardiner, S; et al.  Codeine versus placebo for chronic cough in children. Cochrane Database Syst Rev. 2016, (7).
    • 7.       Oduwole, O; et al.  Honey for acute cough in children.  Cochrane Database Syst Rev. Dec 2014, (3).
    • 8.       https://www.fda.gov/Drugs/DrugSafety/ucm549679.htm
    • 9.       McNamara, M. Cough. The 5 Minute Pediatric Consult. 6th edition. Philadelphia: Wolters Kluwer. 2012. 230-231.

    Brian R Wingrove, MHS, PA-C, DFAAPA

    Past President, Society for PAs in Pediatrics

    Children’s Physician Group – Pulmonology at Scottish Rite

    Children’s Healthcare of Atlanta


  • 24 Jan 2017 5:06 PM | Monique Ochoa (Administrator)
  • 29 Mar 2016 9:27 AM | Monique Ochoa (Administrator)
  • 09 Feb 2016 11:34 AM | Mary Kathryn LeMay (Administrator)

    We have posted our tentative conference agenda on our website.  Go to our 2016 Conference page and check it out.  We can't wait to see you in Vegas!

  • 11 Nov 2015 11:41 AM | Mary Kathryn LeMay (Administrator)

    Our November SPAP Shout Out is now available! Read all about everything that is going on with SPAP.

  • 05 Nov 2015 1:40 PM | Mary Kathryn LeMay (Administrator)

    The Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration would like to inform you about an exciting prize competition: the Bridging the Word Gap Challenge.

    Children from low-income families are exposed to 30 million fewer words than their higher-income peers before the age of three. This is known as the “word gap,” a major issue facing our nation today.

    This gap in parent/caregiver talk is associated with later disparities in school readiness and academic achievement. Children who lag behind their peers early in life are much more likely to have worse outcomes in education, earnings, and family stability as they grow into adulthood.

    By as early as 18 months of age, toddlers from disadvantaged families are already several months behind more advantaged children in language proficiency, and these gaps widen, rather than diminish, over the early elementary years. In fact, children’s academic successes at ages nine and 10 can be linked to the amount of talk they hear from birth through age three.

    To spur innovative solutions to address the word gap, MCHB is announcing the Bridging the Word Gap Challenge. We are inviting you to develop a technologically-based intervention that drives parents and caregivers to talk, and engage in more back-and-forth interactions, with their young children (ages 0-4). The innovative solution will promote the early language environment and address the word gap issue.

    What’s at stake? Prizes of up to $300,000! In addition to cash prizes, participants will receive mentoring and matching opportunities for Phases 2 and 3 of the competition.

    The first phase of the Challenge opens on Friday, November 6th. Registering is easy! Simply visit www.wordgapchallenge.hrsa.gov for further details. Make sure to follow us on Facebook at www.Facebook.com/HHS.HRSA and on Twitter at @HRSAgov using the hashtag #BWGChallenge to stay updated on everything Bridging the Word Gap. For more information about the word gap, watch President Obama’s message on the importance of empowering our nation’s youth.

    We encourage you to pass this information on to your communities, and to any and all individuals who may be interested in participating in this challenge. To help us spread the word about the challenge, you can:

    · Share this email with your friends and colleagues, and direct them to our website at: www.wordgapchallenge.hrsa.gov

    · Share information about the challenge on your social media account. Here are sample posts for you to use:

    o Facebook: Bridging the Word Gap Challenge is everyone’s opportunity to put more American children on the path to success. Participate in the Health Resources and Services Administration’s initiative to bridge the word gap, get awarded, and make a difference: www.wordgapchallenge.hrsa.gov

    o Twitter: Ready to make a difference? Submit your ideas to the #BWGChallenge & win prizes up to $300,000: http://1.usa.gov/1W9UdlF

    We are excited to share this opportunity with you, and look forward to seeing the innovation in your ideas!

    MCH Research Program


  • 08 Oct 2015 10:46 AM | Mary Kathryn LeMay (Administrator)

    Hey Members!  Don't forget that we have job opportunities available on our Job Opportunities page on the website.  This is only available to our active members.  If you'd like to view those opportunities and are not a member already, join us today!

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