Start with the cough syrup

The question usually arrives as: why not put children’s cough syrup in a lollipop or a sweet, so they take it without a fight? For infants the first answer is that they should not be getting cough syrup at all. In October 2025, after the deaths of children in Madhya Pradesh and Rajasthan were linked to cough syrups, India’s Health Ministry advised that cough and cold medicines should not be prescribed or dispensed to children under two, and are generally not recommended under five. The US Food and Drug Administration warned against over-the-counter cough and cold products for children under two in 2008, because they had not been shown to be safe or effective at that age and had been linked to serious adverse events, including deaths.

India has also restricted the commonest combination. The drug regulator asked manufacturers in December 2023 to label the fixed-dose combination of chlorpheniramine and phenylephrine as not for children under four. A notification in April 2025 made the warning binding, and on 18 August 2026 the Health Ministry extended it to every formulation containing the two drugs. In September 2026 the government was reported to be considering a red warning against use under four on cough-syrup bottles generally.

The evidence for the gentlest alternative is modest but real. A Cochrane review of six small trials in 899 children aged 12 months to 18 years found that honey probably relieves cough more than no treatment, diphenhydramine or placebo, and may be about as good as dextromethorphan. Honey is not given to babies under one year because of the risk of infant botulism.

The lollipop literature

Medicine in a lollipop is not new. The best-known example is a prescription opioid. In 1989 anaesthetists at the University of Utah tested oral transmucosal fentanyl citrate — fentanyl in a sweetened lozenge on a stick — as a pre-operative sedative in 44 children. The children readily accepted it, and it sedated them, but at the highest dose three of 12 had brief drops in blood oxygen, and post-operative vomiting ran at 50–83%. The product was later sold for adult cancer pain as Actiq, and regulators worried from the start that a narcotic shaped like a sweet would attract children.

The rest of the literature falls into three groups:

• Herbal lollipops for tooth decay. Lollipops containing liquorice-root extract have been tested in preschool children with a high risk of caries; two a day for three weeks lowered levels of Streptococcus mutans, the main decay-causing bacterium. A 2020 systematic review found only three studies, only one of them high quality, and called the effect promising but asked for larger trials.
• Analgesic lollipops after surgery. A 2026 pilot from anaesthetists in Chile and Venezuela gave a diclofenac lollipop to 50 children aged 4–12 every eight hours after removal of tonsils and adenoids. Pain scores fell, 83% rated the taste and texture positively, and no adverse events were recorded — but there was no comparison group, so the study shows that the lollipop is acceptable, not that it works better than syrup or tablets.
• Laboratory formulations. Most papers on “medicated lollipops” are pharmacy-lab studies that make lollipops containing paracetamol, albendazole, cefixime, salbutamol or fexofenadine and measure how fast the drug dissolves. They report drug release in minutes, not outcomes in children; none of the ones found for this piece tested the lollipop in patients.

Every one of these was tested in children old enough to manage a hard sweet. None was tested in infants, and there is a reason.

Why sweets are the wrong vehicle for babies

Choking. The American Academy of Pediatrics advises against giving hard sweets to children under four. Hard candy was the food most often involved in non-fatal choking visits to US emergency departments in a study of children published in Pediatrics in 2013. A lollipop also cannot deliver a measured dose to a child who is not old enough to suck it steadily.

Accidental overdose. A medicine that tastes and looks like a sweet invites children to take more of it. Melatonin gummies are the clearest recent case. The US Centers for Disease Control and Prevention reported that poison-centre calls about children swallowing melatonin rose 530% between 2012 and 2021, and that during 2019–2022 melatonin was involved in about 11,000 emergency visits by infants and young children for unsupervised ingestion, 7% of all such visits. In 47% of those cases the child had eaten gummies. Most cases were mild, but the data cover 4,097 hospitalisations and two deaths over the decade.

Dose control. A cough syrup in a sweet would also hide the dose. Paediatric doses are calculated by weight, and the problem with liquids is already measurement error with spoons and cups; a sweet that is half-eaten, shared or put down solves none of that.

What the trials actually show for infants

The surprising finding of the past 15 years is that babies can take solid medicines. A group at the University Children’s Hospital in Düsseldorf expected children to prefer syrup. Their own trials showed the opposite.

From the PubMed abstracts of each study. The mini-tablet and film trials used drug-free placebos to test acceptability and swallowing, not the effect of any medicine.

Three other approaches are in use or close to it:

• Dispersible tablets. The World Health Organization’s guidance on medicines for children prefers “flexible solid” forms — tablets that dissolve in a little water or on the tongue — especially for low-income settings. They are more stable than syrups, easier to transport and need fewer potentially toxic additives. Dispersible amoxicillin for childhood pneumonia is the standard example, and in May 2024 the WHO prequalified arpraziquantel, a 150 mg dispersible tablet for schistosomiasis in children aged three months to six years, made less bitter for small children.
• The nipple shield delivery system. Developed by the JustMilk project, this is a thin silicone shield worn during breastfeeding that holds a dissolving insert, so the medicine is released into the milk the baby drinks. It has been tested with zinc in a breastfeeding simulator and in acceptability studies with mothers, including for HIV drugs to prevent mother-to-child transmission; it has not yet been licensed for a medicine. The UK vitamin B12 study above tested the same idea of giving a solid dose during a feed.
• Taste-masked and 3D-printed doses. Chewable printed doses, shaped and flavoured for a child, are being tested in hospital pharmacies for rare diseases that need exact, individual doses.

Where India stands

India’s paediatric market still runs on syrups and drops, and that is where its worst drug-safety disasters have happened. Coldrif, made by Sresan Pharmaceuticals in Tamil Nadu, was found to contain diethylene glycol at 48.6% in one batch; the deaths of 24 children in Madhya Pradesh were linked to it, the firm’s licence was revoked, and the WHO issued an alert on Coldrif and two other Indian syrups, Respifresh TR and ReLife. Indian-made syrups were linked earlier to child deaths in the Gambia and Uzbekistan.

Diethylene glycol gets into syrups through the solvents and sweeteners that liquids need — propylene glycol, glycerin and sorbitol — when a manufacturer buys a contaminated or substituted batch and does not test it. A dispersible tablet, mini-tablet or film for the same drug needs little or none of those solvents. Switching the youngest children away from syrups would remove one route for the poison, as well as making doses easier to measure.

A lollipop would not. It is a sugar matrix, and hard-boiled sweets are made from the same sugars and syrups; it carries the choking and accidental-overdose risks above, and for infants it delivers a class of medicine India has already told doctors not to prescribe.

Indian companies already make them — for other markets

India does not lack the technology. Its drug makers produce child-friendly solid medicines and oral films at scale, but the paediatric products go mainly to donor-funded HIV and tuberculosis programmes abroad, and the films mainly to adult markets in Europe.

From company announcements, regulators’ decisions as reported, and the DNDi, CHAI, Unitaid and TB Alliance releases cited below. “Tentative approval” means the FDA found the product met its standards for supply under the US PEPFAR programme while patents block sale in the US.

The pattern is clear. Indian firms have shown they can make mini-pellets, dispersible tablets and films for babies when an international buyer — PEPFAR, the Global Fund, Unitaid — asks for them and pays. The films they sell in Europe are for erectile dysfunction, migraine, blood clots and opioid dependence. The domestic paediatric market, where most medicines are bought privately and prescribed by brand, still asks for syrups and drops, and gets them. A film or mini-tablet costs more to develop, and there is no Indian requirement or procurement preference for them yet. India’s drug regulator did approve an ondansetron oral film for nausea as early as 2010, so the route exists.

What would fix this

• The Central Drugs Standard Control Organisation should make the warning against cough and cold medicines for children under two binding, by notification and on labels, rather than leaving it as an advisory that, according to complaints reported in 2026, some doctors have ignored.
• The Indian Pharmacopoeia Commission should publish monographs and quality standards for mini-tablets, orodispersible films and dispersible tablets for children, so that Indian manufacturers have a clear route to make them and state regulators a standard to test them against.
• The Ministry of Health and Family Welfare should prefer dispersible and other solid child formulations in the National List of Essential Medicines and in state free-medicine schemes, following the WHO’s guidance, so that public procurement does for Indian children what donor procurement has done for HIV and TB treatment abroad — and gives Cipla, Macleods, Laurus, ZIM, Shilpa and others a domestic market for what they already make.
• The Food Safety and Standards Authority of India and the CDSCO should jointly bar the sale of medicines or supplements for children in lollipop, gummy or sweet form without child-resistant packaging and a dose limit per pack, before such products become common in India.
• The Indian Council of Medical Research should fund acceptability trials of mini-tablets and films in Indian infants, so that the German and UK results are tested where the syrup problem is largest.

These are proposals from this blog, not recommendations any agency has adopted.

Sources and caveats

About this article: Researched, written and edited by Umashankar Triplicane Dwarakanathan, with AI research assistance; every figure is meant to trace to the primary source cited. See the Editorial Policy for how sourcing, AI use and corrections work.