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Over-the-counter cough and cold medicines are widely prescribed by general pediatricians in order to relieve cough and other symptoms in the setting of upper respiratory infections. This article will review the pharmacologic components found in over-the-counter cough medicines, the data concerning their use and efficacy in children, the increasing trend of abuse of these medications, and their potential toxicity.There is an overall paucity of data evaluating the use of over-the-counter cough medicines in children as well as a lack of evidence for their efficacy. The articles cited will review the efficacy of over-the-counter cough medicines, the emerging trend of abuse of certain preparations such as dextromethorphan, and specific cases of morbidity and even mortality.According to the limited data that exist, there is not any evidence that over-the-counter cough and cold medicines are effective in children. In otherwise healthy children without chronic complicating factors such as asthma, the symptoms of acute upper respiratory infections are generally mild and self-limited. Pediatricians must weigh the benefits against the potential risks of recommending over-the-counter cough medicines and should be prepared to educate parents about the expected natural course of their child's illness and the likelihood that these medications will be minimally effective in relieving symptoms, if at all.