A new population-based study published in the European Journal of Pediatrics reveals that cough and cold medicines (CCMs), including opium alkaloids, continue to be prescribed to children in Finland despite long-standing clinical guidelines advising against their use. The study (collaboration with KELA and Tampere University), analyzed over 96,000 prescriptions issued between 2017 and 2023 and offers critical insights into current pediatric prescribing practices.
The research shows a substantial decline in CCM prescriptions during the study period—particularly among children aged 2–5 years—yet the use of potentially harmful opium derivatives remains widespread. In 2023, nearly all CCM prescriptions for children under two still contained opium alkaloids.
“While the overall reduction in prescribing is encouraging, the persistence of opium-containing medicines in young children is a serious concern given the risks of respiratory depression and other central nervous system effects,” said Dr. Csonka. “These findings underscore the urgent need for stronger, multifaceted strategies to align clinical practice with current evidence and safety standards.”
Key findings from the study include:
- A 79% drop in CCM prescribing among 2–4-year-olds from 2017 to 2020, but no return to pre-pandemic levels in any age group.
- Opium derivatives remained the most commonly prescribed CCMs for children under 12 throughout the study period.
- Non-specialist physicians and medical students issued nearly 60% of all CCM prescriptions in 2023.
- Private and public sectors showed similar overall prescribing rates, though specialist physicians were more active prescribers in the private sector.
The study authors call for national campaigns aimed at educating healthcare professionals –particularly non-specialists and trainees – about the risks and limited benefits of CCMs in children. They also advocate for real-time decision support tools and public information campaigns to reduce unnecessary demand for such medicines.
“Reducing inappropriate cough medicine use in children requires more than guidelines. Regulatory action, education, and system-level interventions – like prescription monitoring and clinician feedback – can drive safer, more effective care,” Dr. Csonka added.
The full study, “Cough medicine prescriptions for children by physician specialty and healthcare sector: a Finnish population-based nationwide register study,” is freely available online (link opens in European Journal of Pediatrics website): https://doi.org/10.1007/s00431-025-06306-2