Despite parents being warned about potentially dangerous compounds in cough syrups, a lack of understanding of the risks posed by the harmonizations like diethylene glycol/ethylene glycol and age-restricted actives like dextromethorphan, codeine, and promethazine still prevails. Recent scenarios in India’s Rajasthan and Madhya Pradesh are summarized, along with tips on label reading and safer options.
Why should extra caution be taken with children’s cough syrups?
Caution needs to be amplified for children’s products, as children’s bodies are still at the developing stage, and drug components, as well as aggravating constituents, can lead to adverse reactions at relatively lower doses. Paediatric experts have identified insufficient evidence regarding the use of many OTC cough and cold products in this population, and their recommendation is non-drug interventions.
What has been reported regarding recent incidents in India (October 2025)?
Reports have surfaced stating that diethylene glycol and ethylene glycol are ingredients in Kaysons Pharma’s cough syrup, manufactured in Rajasthan.
This information came alongside reports stating that 11 children in total, nine in Madhya Pradesh and two in Rajasthan, died after allegedly taking syrup that was contaminated.
As a precaution, a halt has been placed on the entire supply of 19 products that the company has manufactured.
Warning labels will be placed on drugs that pose a risk to children and pregnant women.
The Principal Secretary (Medical & Health), Gayatri Rathore, noted that per an advisory of the Union government in 2021, dextromethorphan must not be given to children below the age of four.
As per an official statement, the Health Minister Gajendra Singh ordered an inquiry and public interest safeguarding measures to be instituted.
Common harmful ingredients or red flags to look for
When paediatric cough syrups are to be assessed, the following ingredients, as well as the issues mentioned, ought to raise concern. Labels must be checked, and in case of any doubts, a pharmacist or paediatrician must be asked.
Diethylene glycol (DEG) / Ethylene glycol (EG)
These industrial solvents must never be present in medicinal syrups. Even a small quantity of any of these compounds will lead to acute kidney injury, metabolic acidosis, and possible death, particularly in children. Risks are also present when contaminated excipients (glycerin or propylene glycol, for example) are used.
Dextromethorphan (DM or DXM) in young children
The scheduled routine use in children under four years of age is not advised, as it can lead to drowsiness and agitation. Overdoses or combinations with other medicines can result in breathing issues.
Codeine or hydrocodone (opioids)
In many locations, the use of these drugs in children has been restricted or banned because of the danger of severe respiratory depression, which can be fatal.
Promethazine
There are strong contraindications. It is banned for children under two years of age because of the risk of respiratory depression that can be fatal. In older children, it should be used very cautiously and only under medical supervision.
First-generation antihistamines (e.g., diphenhydramine) and decongestants (e.g., phenylephrine, pseudoephedrine)
These are not recommended for children under two years, and most pediatric organizations recommend avoiding them for children four to six years of age due to limited benefits. The potential side effects (sedation, agitation, and changes to heart rate) make this restriction even more critical.
Herbal mixtures or other mixtures of unknown composition and high alcohol content
High ethanol content may increase the chance of dangerous interactions and oversedation. The mixtures also have unregulated components, which is an additional risk. Check the label and composition of the batch.
How DEG and EG Contaminate Syrups and Why It Matters
In paediatric “liquid” medications, it’s the improper or untested adulteration of the solvents or excipients that allows glycerin or propylene glycol to be contaminated with DEG or EG. After many international disasters, the proposal of stronger controls on suppliers and targeted testing of high-risk inputs is even more prevalent.
Syrups consumed by children can cause the following symptoms of urinary obstruction and possible rapidly progressive acute renal failure: vomiting, abdominal pain, confusion, and reduced urine output.
What parents and caregivers can do (practical checklist)
For children aged 4-6, constant use of over-the-counter cough and cold syrups should be avoided unless directed by a clinician. Children under two should not use decongestant and antihistamine products at all.
Reading labels carefully is essential. Active ingredients, age designation, alcohol content, batch/ lot number, manufacturer name, and expiration date should be checked.
For children under the age of 6, do not use multi-ingredient products, and if a treatment is necessary, use single-ingredient approaches as they are safer.
First, use non-drug means. Symptoms can be treated with fluids, honey (for children over one year), nasal saline, and humidified air.
Keep all receipts and boxes from your purchases so that if a batch recall is issued, you can prove the purchase. Do not forget that the syrups purchased should be from reputable pharmacies.
If a syrup causes strange symptoms, discontinue use and seek emergency care. Bring the bottle along so health care providers can note the batch and manufacturer.
Reporting adverse events to the appropriate authorities helps with investigations and potential recalls.
Changes in Policy and Labelling That Parents May See
Provisional assessments in Rajasthan have led to the introduction of mandatory warning labels on certain medications. These labels indicate that the medications may be harmful to children and pregnant women. As a precautionary measure, the distribution of all 19 medications from the manufacturer under investigation has been suspended. Renewed focus on the 2021 advisory, which cautioned the use of dextromethorphan in children under four, has been noted.
FAQs
Is any cough syrup “safe” for toddlers?
Generally, other non-drug measures are preferred first. For children under two, cough and cold medicines are usually discouraged, and for ages two to six, use should occur only with a clinician’s permission.
Which ingredients should be avoided altogether?
The use of products that contain codeine or hydrocodone and promethazine, especially in very young children, should be avoided altogether. Any product that has been associated with DEG/EG should also be avoided.
How can contamination be prevented at the source?
It is expected that manufacturers test high-risk excipients, validate suppliers, and adhere to stringent quality control processes, while regulators provide surveillance and issue alerts or recalls when contamination is suspected.
Take extra care when it comes to children’s cough syrups. Some cough syrups may contain dangerous substances (DEG/EG) or active ingredients for older children. Moreover, between 4 months and 5 years, syrups provide limited help. Parents should read labels very carefully, seek non-drug alternatives, and talk to a doctor or pharmacist before giving medication to children.
This article is for informational purposes and does not substitute for individual medical advice.
