Some of the 103 children who died after being given the cough and cold may have been deliberately given overdoses to sedate or even kill them, Bloomberg News writes, citing a study in the Annals of Emergency Medicine that examined deaths over the past four decades.

The children who died after taking the drugs ranged in age from 28 days to 10 years, with 75 percent younger than two years old. In 26 cases, the reviewers determined that a child was given the medication with “nontherapeutic intent.” And 10 died in day-care facilities (here is the study).

You may recall an FDA advisory panel recently urged that OTC cough and cold meds should not be given to children younger than 6 years old. Drugmakers voluntarily changed the labels on the medicines to warn against their use in children younger than four years old (back story).

This step won’t protect children whose caregivers administer overdoses to sedate or quiet them, according to Richard Dart, the lead author. “The whole discussion has been portrayed as innocent parents giving their kids medicine and their child is dead,” he tells Bloomberg. “We’re not saying the confused parent who gives an overdose accidentally isn’t important. It is, and we should protect them. But we shouldn’t forget that a significant portion of these cases is not going to be addressed” by the label changes.

Dart began the investigation after he looked into the death several years ago of two children who died after their father, a taxi driver, gave them cold medicine to quiet them so he could sleep. The study listed 10 deaths as suspected homicides, Bloomberg writes. Another 10 deaths in day-care centers may have been due to poorly trained child-care workers using the medication to control behavior. In some cases, children drank the medication out of a glass, instead of a small dropper.

“Presumably these centers are not trying to kill their own clients,” Dart tells Bloomberg. “They’re doing stupid things out of ignorance. These are over-the-counter products and I think people don’t recognize the risks.”

The reports were drawn from poison control agencies, the FDA and drugmakers. The research was supported by funding from McNeil Consumer Healthcare, a unit of Johnson & Johnson that makes OTC cold meds. McNeil was among those that withdrew several products aimed at infants last year.