‘Cough is not a disease, but a symptom’: Kerala issues strict guidelines for treatment in children

The department emphasized that the guidelines are aimed at ensuring safe, evidence-based treatment and preventing unnecessary and unsafe use of cough syrups in children.

South First Desk

Published Oct 09, 2025 | 7:57 PM ⚊ Updated Oct 09, 2025 | 7:57 PM

Child coughing (iStock)

Synopsis: The guidelines provide a clear clinical approach and management protocol for cough in children, covering types of cough, symptoms, chronic and persistent cases, clinical examination procedures, non-pharmacological first-aid measures, dosage and safety considerations, and key instructions from the Kerala Drugs Controller.

The Kerala Health Department on Thursday, 9 October, released a comprehensive technical guideline on the treatment of cough in children and the use of cough medicines, in the wake of reports of child deaths linked to cough syrups in other states.

Urging strict adherence to the new guidelines, Health Minister Veena George noted, “Cough is not a disease but a symptom. Parents and caregivers should never self-medicate children. Medicines should be given only as prescribed by a qualified paediatrician.”

The state government had earlier appointed a three-member expert committee to study the issue, and the new guidelines have been prepared based on its report. It is intended for doctors, health workers, pharmacists, and the general public.

The guidelines provide a clear clinical approach and management protocol for cough in children, covering types of cough, symptoms, chronic and persistent cases, clinical examination procedures, non-pharmacological first-aid measures, dosage and safety considerations, and key instructions from the Kerala Drugs Controller.

Also Read: Inspection finds 364 violations at Kanchipuram Coldrif facility

Age-specific guidance for cough syrup use

The guideline states that:

Cough syrups should not be given to children below 2 years of age.
For children aged 2 to 5 years, cough syrups should generally be avoided and, if necessary, administered only after clinical assessment under special observation.
For children above 5 years, they should be given only in small doses and for a short period, after a special assessment.
All cough syrup products distributed in health facilities must meet proper manufacturing standards and be free from harmful impurities such as diethylene glycol (DEG) and ethylene glycol (EG).

Instructions for pharmacists and caregivers

Pharmacists have been directed to strictly follow the Drugs Controller’s instructions, ensure the quality and expiry of medicines, and source only from certified manufacturers.

The Health Department has also issued a set of instructions to the public:

Do not ask for cough syrups or formulations without a prescription.
Do not use leftover medications or expired prescriptions.
Do not give medication prescribed for one child to another.
Seek medical attention immediately if the child has symptoms such as chest pain, breathlessness, hemoptysis, seizures, or altered sensorium.

The department emphasized that the guidelines are aimed at ensuring safe, evidence-based treatment and preventing unnecessary and unsafe use of cough syrups in children.

All stakeholders have been directed to follow the guidelines without exception.

Also Read: Four southern states ban cough and cold syrups for children

(Edited by Sumavarsha, with inputs from Dileep V Kumar)