Dear Doctor Column, November 17, 2008

Easing Cold Symptoms in Children   

 Question:

Why is it a bad idea to give cold medicine to children? If I shouldn’t use these medications, what should I do when my child has a cold?

Answer:

More than 800 cold and cough medications for children are sold in the United States. There are a number of reasons for the recent warnings not to give these drugs to young children. “First, there is no scientific evidence that any of these medicines work in children, and there are some serious risks that we do know about,” says UAB pediatrician Carolyn Ashworth, MD.

Early in 2008 the Food and Drug Administration released a strong recommendation against using cold and cough medicines in children younger than 2 years because the products can cause serious, potentially fatal side effects. A review by the organization found that in the last 37 years there have been 54 deaths in children due to decongestants and 69 due to antihistamines. The Centers for Disease Control and Prevention report that emergency department physicians treat more than 7000 children younger than 11 each year for reactions to cough and cold medicines.

“Serious adverse events occur because there is not enough reliable information about safe dosages of these medications in children,” Ashworth says. Scientists have conducted most research on these drugs in adults, and there is little data on how the medications affect children.

“To give these medications to children without knowing the safe dosage ranges and without evidence that the medicines work while knowing there are sometimes fatal complications is irresponsible and dangerous,” Ashworth says.  

 Most health complications linked to the use of cough and cold medicines in children are due to a child receiving too large a dose, either through improper measuring of the drug – using a regular spoon instead of the measuring device designed for the product, for example – or using more than one medicine with the same active ingredient. Many medications are designed to treat multiple cold symptoms with several active ingredients, such as a decongestant, a cough suppressant, a pain and fever reducer, and an antihistamine to relieve sneezing or a runny nose.

If you’re giving children more than one medicine and both drugs contain the same active ingredient they could get a potentially dangerous dose. Parents should not, for example, give a child two medicines that both contain a decongestant or an antihistamine.

The FDA is conducting an extensive review on the safety and effectiveness of cold medicine in children. In October 2008, one of its expert panels reported that the drugs don’t work in children younger than 6 years. The FDA will continue to review evidence before making a final decision on recommendations, but drug manufacturers have begun changing their labels voluntarily to state the medicines shouldn’t be used in children younger than 4 years.

Ashworth and UAB toxicologist Erica Liebelt advise parents not to give cough and cold medications to children younger than 6 years. Liebelt notes, “We have good scientific evidence that these medicines don’t work in young children, therefore there is no need to subject them to ineffective and potentially dangerous drugs that can cause side effects, which can include excessive drowsiness, hyperactivity, confusion, and hallucinations.”

“Colds must run their course,” Ashworth says. “Although the first couple of days can leave cold sufferers with a low fever and feeling ill and fatigued, these symptoms improve quickly. Congestion and cough can last longer, but also will improve with time,” she says.

Alternatives to Cough and Cold Medicine

Liebelt and Ashworth advise parents to educate themselves about colds and understand that neither over-the-counter medicines, which address symptoms only, nor antibiotics, which aren’t effective against the viruses that cause colds and can’t relieve symptoms, will make children get well faster.

They advise trying to ease symptoms with alternative methods such as saline nose drops to help clear stuffy noses; elevating the mattress and thus the head of the bed to help drain congestion; using a cool-mist humidifier to moisturize nasal passages; and giving plenty of fluids – warm fluids in particular can ease sore throats. Warm apple juice, warm milk, and even warm water can provide relief. Avoid citrus juices, which can irritate sore throats. Ashworth also advises skipping teas and honey. Children don’t need the caffeine and herbal teas and specialized brews for colds could pose a health risk. Honey contains spores that can cause botulism in children younger than 2 years.

As long as parents have a doctor’s okay they can give ibuprofen (Motrin) to children as young as 6 months for the sore throat and achiness that can come with a cold, Liebelt says. “Once children are 1 year old or older, parents can use their own judgment to administer ibuprofen,” she says. Sucking on peppermints also can relieve sore throats, though hard candies are safe only for children aged 6 years and older – younger children could choke on them.

“Sucking on hard candy helps generate salvia, and as you swallow, you rinse off the secretions draining down the back of the throat. Peppermints taste better than most cough drops and there is no scientific data showing medicated drops work better than peppermints, but the medicated ones sure cost more,” says Liebelt, who notes that the not uncommon belief that alternating acetaminophen [Tylenol] and ibuprofen works better to lower fevers than either of drug by itself is not backed up by any scientific evidence. 

“Furthermore,” she says, “using two different medications with different dosing instruments [cups versus syringes, for example] and different concentrations increases the risk of a parent making an error, such as using the Tylenol dosing cup for the ibuprofen. There have been reports in the literature of otherwise healthy children developing acute renal failure from this practice and there are many cases of liver failure in children who have received large doses of acetaminophen.”

The bottom line, say Ashworth and Liebelt, is that the best (and only) cure for a cold is time. They advise cold sufferers to drink lots of fluids and get plenty of rest. In addition Ashworth says, “Families can cut the risk of spreading colds by washing their hands frequently, cleaning dishes thoroughly, and never drinking after anyone.”

Visit the Web site of American Academy of Pediatrics to learn more about children and cold medicines and get more tips on non-pharmaceutical methods to ease cold symptoms.