# Cough medicine prescriptions for children by physician specialty and healthcare sector: a Finnish population-based nationwide register study

## TL;DR

This study examines how often cough medicines are prescribed to children in Finland, finding that despite guidelines, these medicines are still commonly prescribed, especially by non-specialists and medical students.

## Contribution

The study reveals that opium alkaloids remain frequently prescribed to young children despite safety concerns and highlights the role of non-specialists and medical students in CCM prescriptions.

## Key findings

- CCM prescriptions decreased significantly from 2017 to 2023, especially in children aged 2–4.99 years.
- Opium alkaloids and their derivatives were the most commonly prescribed CCMs for children under 12.
- Non-specialists and medical students issued a large proportion of CCM prescriptions in both public and private sectors.

## Abstract

Despite clear clinical guidelines advising against the use of cough and cold medicines (CCMs) in children, these products continue to be prescribed. We aimed at describing recent trends and identifying deviations from guidelines to inform future targeted interventions. We retrospectively retrieved data on all CCM prescriptions for children under 16 years of age in Finland between 2017 and 2023 from the centralised nationwide prescription registry. Descriptive statistical methods were used to analyse the data, stratified by child’s age, CCM type, physician’s employment sector, and medical specialty. The dataset included 96,499 prescriptions for 75,281 children. Overall, CCM prescribing decreased significantly from 2017 to 2023, particularly between 2017 and 2020, with the steepest decline in the 2–4.99-year age group. Prescribing levels did not return to pre-pandemic levels in any age group. Opium alkaloids and their derivatives were the most commonly prescribed CCMs for children under the age of 12. CCM prescribing rates were nearly identical across public and private sectors. Approximately 40% of prescriptions were issued by non-specialists and 18% by medical students—who constituted the largest group of public sector prescribers. In the private sector, the most frequent prescribers were paediatricians, non-specialists, general medicine specialists, and otolaryngologists. Conclusions: CCMs and especially opium alkaloids and their derivatives are still being prescribed even to small children. These findings should prompt nationwide multifaceted clinical guidance campaigns and interventions targeting medical students and non-specialist physicians, as well as private sector providers, including paediatricians and other specialists.
What is known:• Despite guidelines advising against cough and cold medicines (CCMs) in children, prescribing persists.What is new:• CCM prescriptions for children declined markedly in Finland between 2017–2023, however opium alkaloids remained the most common among children under 12, despite CNS safety concerns. Non-specialists, general practitioners, and medical students prescribed CCMs most frequently. Specialist physicians were more likely to prescribe CCMs in the private sector, while the public sector had a broader mix of prescribers.

What is known:

• Despite guidelines advising against cough and cold medicines (CCMs) in children, prescribing persists.

What is new:

• CCM prescriptions for children declined markedly in Finland between 2017–2023, however opium alkaloids remained the most common among children under 12, despite CNS safety concerns. Non-specialists, general practitioners, and medical students prescribed CCMs most frequently. Specialist physicians were more likely to prescribe CCMs in the private sector, while the public sector had a broader mix of prescribers.

The online version contains supplementary material available at 10.1007/s00431-025-06306-2.