OTC Medications Expose Toddlers to Potentially Risky Parabens

Common OTC liquid medications may be exposing toddlers to parabens at levels that warrant a closer look into what's actually in the pediatric drugs stocked on pharmacy shelves, according to a study in the Journal of Hazardous Materials Advances.¹

“Parabens, esters of p-hydroxybenzoic acid, are widely used as antimicrobial preservatives in cosmetics, food packaging, and pharmaceutical products,” wrote the authors of the study. “Their extensive use in various consumer products has led to widespread human exposure to parabens.”

Recent research reveals that pediatric OTC liquid medications are an important, yet often underrecognized, source of high-level paraben exposure in toddlers.¹ A comprehensive study analyzing 82 products across 13 countries highlights that, while these antimicrobial preservatives are necessary to prevent the growth of harmful bacteria and mold in aqueous formulations, their contribution to the internal chemical body burden in children is significant.^1,2

READ MORE: Most US Adults Regularly Use OTC and Prescription Medication

For pharmacists, these findings underscore a critical need to evaluate formulation choices and enhance caregiver education regarding the safety and administration of liquid drugs.^1,3

Deciphering Parabens’ Effects on Pediatric Patients

The study found substantial variation in paraben concentrations and types depending on the country of origin. For instance, although samples from the US only contained benzoic acid, medications from Korea, Finland, and Malaysia showed high levels of methylparaben and propylparaben. Benzoic acid is generally recognized as safe by the FDA and is rapidly metabolized by the liver, yet it remains a point of investigation due to potential pro-oxidant effects.¹

Parabens like methylparaben, ethylparaben, propylparaben, and butylparaben, however, are classified as endocrine-disrupting chemicals (EDCs) because they can mimic the hormone estrogen, according to the Cleveland Clinic.⁴ Because children have a higher relative intake and lower metabolic capacity to detoxify chemicals, they are particularly susceptible to these EDCs, which have been linked to risks in hormonal and neurocognitive development as well as allergy.¹

Although parabens typically leave the body through urine within 24 to 48 hours, the concern lies in chronic or episodic high-level exposure. Research indicates that reducing exposure to these chemicals can provide almost immediate results, with paraben concentrations in some adolescents dropping by 40% after just 3 days of avoiding products containing them.⁴

Pharmacists Intervening in Parent-Directed OTC Use

For pharmacists, the key challenge is compounded by the high prevalence of parent-directed medication use. Approximately 64% of parents admit to giving their children medications without consulting a health care provider, often driven by time constraints or the availability of old prescriptions.⁵

Many caregivers perceive OTC drugs and those with parabens as safe, particularly home remedies or complementary and alternative medicines, which they may mistakenly believe are risk-free because they are natural products.

The risk of unnecessary exposure is further exacerbated by dosing inaccuracies. A randomized experiment found that over 84% of parents made at least one dosing error for their children, with large errors being most common when using dosing cups rather than oral syringes, according to a study in Pediatrics.⁶

Pharmacists must actively intervene by recommending oral syringes, which are the most accurate tools, especially for doses under 5 ml. It is crucial to instruct parents to never use kitchen spoons, which vary widely in size and lead to improper dosing.^6,7

Furthermore, pharmacists should be aware that the FDA and the Consumer Healthcare Products Association (CHPA) offer inconsistent age recommendations for cough and cold products, which can leave caregivers confused.³

Looking Ahead

The pharmacist serves as a vital safeguard in pediatric health. By providing evidence-based information, ensuring caregivers use appropriate dosing tools marked in milliliters, and inquiring about all self-medication practices, pharmacists can minimize the risks associated with improper dosing and unnecessary chemical exposure.^5,7

As researchers advocate for the substitution of parabens with safer alternatives in pediatric formulations, the role of the pharmacist in educating the public on safe product selection and administration remains more critical than ever.^1,3

“These findings call for a re-evaluation of paraben use in pediatric pharmaceuticals in Korea, regulatory actions to encourage the substitution of parabens with safer preservative alternatives where feasible, and enhanced transparency in the composition of children’s medications,” concluded the authors of the current study.¹ “Such measures would help protect children from preventable and unnecessary exposure to parabens.”

READ MORE: OTC Resource Center

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REFERENCES

1. Ihn Y, Kim S, Lee G, et al. Parabens in over-the-counter drugs for pediatric use and their contribution to body burden. J Hazard Mater Adv. 2026;21:101085. https://doi.org/10.1016/j.hazadv.2026.101085

2. Parabens in cosmetics. FDA. November 18, 2025. Accessed March 10, 2026. https://www.fda.gov/cosmetics/cosmetic-ingredients/parabens-cosmetics

3. Condren M. Ensuring safe use of over-the-counter cough and cold products in children. J Pediatr Pharmacol Ther. 2009 Jul;14(3):124-6. doi: 10.5863/1551-6776-14.3.124.

4. Should you worry about parabens? Cleveland Clinic. November 20, 2024. Accessed March 10, 2026. https://health.clevelandclinic.org/what-are-parabens

5. Seth S, Dubey AK, Maheshwari N. Parent-directed use of over-the-counter medications and complementary and alternative medicine therapies among pediatric patients: a cross-sectional study. J Res Pharm Pract. 2023 Aug 29;11(4):151-161. doi: 10.4103/jrpp.jrpp_15_23.

6. Yin HS, Parker RM, Sanders LM, et al. Liquid medication errors and dosing tools: a randomized controlled experiment. Pediatrics. 2016;138(4):e20160357. https://doi.org/10.1542/peds.2016-0357

7. How to use liquid medications. American Academy of Pediatrics Council on Quality Improvement and Patient Safety. February 21, 2024. Accessed March 10, 2026. https://www.healthychildren.org/English/safety-prevention/at-home/medication-safety/Pages/Using-Liquid-Medicines.aspx