Live Q&As

The desire to make our kids feel better when they are sick is the reason it's so frustrating that cold medicines don't work. I have some patients who are convinced cold medicine helps their children. If the child is over age six, I don't mind parents using medication because the risks are low. That being said, if they don't see relief after a few doses, it's unlikely to be helpful. In children less than six, you are mostly stuck with fever and pain control, a vaporizer and hydration to relieve nasal congestion.

Nasal congestion is very difficult to treat in young children and kids less than four are not good a blowing their noses. Some parents find that nasal washes are helpful, but like you, many also find that their children hate anything getting near their nose. A warm, wet washcloth sometimes helps a stuffy nose, though it won't do anything to reduce the internal congestion.

For thumb suckers, colds are especially difficult to deal with. My eldest sucked her thumb until she was six and anytime she got a cold we had rough nights because she couldn't sleep. 

It's common that babies and older children don't want to eat when they are sick. Keeping them hydrated is more important than eating in this situation. When children are sick, three things commonly make them vomit. (1) Coughing (2) Being given a medicine they don't want (3) Swallowing all of the mucus that accompanies a cold.

The best way to deal with cough-induced vomiting is to give babies smaller feedings more often. For a breastfed baby, we often ask moms to feed for five minutes at a time. If the baby is bottle fed, we reduce the amount to an ouce or less if necessary to reduce vomiting. Some babies will keep water or Pediatlyte down better than milk so that's another option.

Fever is a response of the body's immune system to fight infection. We treat fever to make children feel better, which in turn makes them more cooperative eating and drinking and helps them sleep at night. There is no set temperature where you need to treat a fever. 

For more information on fever, go to the Parent's Page on my website, www.howardjbennett.com. I have an article that discussed fever management in detail.

Cold medicines are designed to reduce the symptoms of a cold: congestion, runny nose, cough, etc. They may also contain acetaminophen or ibuprofen because colds are often accompanied by fever or pain. The antihistamines in cold medicines can also be used for allergies. The pain relievers and fever reducers in cold medicines can be used for headaches or a bruised knee. However, that doesn't make them cold medicine. Doctors usually suggest that people take medicine for specific reasons so there is no reason to take a degongestant with acetaminophen if you just have a headache. I'd suggest taking acetaminophen instead.

Remedies like the ones you mentioned do not work for colds. They were recommended in the past before research was available to provide data on what works and doesn't work when people are sick.

Keep her hydrated with fluids or foods like applesauce, etc. Use a fever reducer/pain reliever if necessary for discomfort. Try some honey. Give her 1/2 to 3/4 teaspoon every few hours. If the honey works, you can use it for a few days. If it doesn't work, you can try elevating her bed a few inches. In some cases, children sleep better at night in their parents' arms. Uggh!

Just the simple things I mentioned in the article and have addressed so far in the online chat. Lots of parents tell me that a dose of acetaminophen "knocked their child out" at night. When I hear this, I remind folks that acetaminophen doesn't make kids sleepy. What happened in that instant is the medication made the child feel better, which allowed her to fall alseep.

Most of the research has been done on adults, but there have been numerous studies that have been carried out on kids. A lot of the research on colds isn't done well, which is why not all studies were reviewed by the Cochrane group that I mentioned in the article. When they looked at well done studies, it was found that cold medicines don't work in children under six and provide a small benefit in children ages six to twelve. The FDA is currently looking at this data before making a recommendation of their own.

None of the cold medicines on the market say they can cure a cold. Instead, they claim to improve the symptoms. You can see this in print as well as TV ads. But the truth is that most medicine that is designed to stop a runny nose, thin mucus or reduce cough in children doesn't work. That's why parents report over and over that cold medicine doesn't relieve their kid's symptoms. I sometimes hear that medicine does work, but that's usually because cold symptoms wax and wane during the day. If you give Triamini at 9am and your child feels better at 10am, you'll think is was because of the drug. However, controlled reserach shows that a child is just as likely to be better at 10am if he got placebo rather than Triaminic.

The same thing isn't true for acetaminophen and ibuprofen. They are designed to reduce fever and pain and they accomplish this task most of the time.

Fluids, rest, distraction (books, games, TV), vaporizers, fever medicine, pain relievers, honey (for cough in children over 12 months), TLC and chicken soup.

Keep in mind that my primary audience in today's article was parents. Cold medicines like Sudafed and Mucinex provide relief in some adults. Sinus washes help lots of adults as well.

Personally, I am a big fan of Zicam. I have viral-induced asthma and taking Zicam at the first sign of a cold almost always makes me feel better sooner and makes it less likely that I will develop wheezing with a cold. It messes up my taste for days, but that's worth it in my opinion. I don't use Zicam with children, however, because it can cause nausea and we don't have enough data on its effectiveness in that age group.

This sounds like a typical separation/sleep issue in a toddler. I'd recommend discussing it with your child's doctor since it is not related to the subject of today's online chat.

You made some very good points. The purpose of the article was to address the nature of colds and their treatment. That being said, your philosophical take on illness is a good one.

The research on colds isn't done in a lab. Patients see the doctor and go home with either a placebo or an actual drug. They keep a log of the child's symptoms and at the end of the study look to see if the child was more likely to get better after the drug rather than the placebo. The drug rarely wins.

Decongestants come as liquids and nose drops. As you said, the nose drops work and I wouldn't refute that. Unfortunately, during the time that the nose drops are working, the cells lining the child's nasal passages aren't getting enough oxygen so when the medicine wears off, the child is often more congested. After a few days, this can lead to chronic nasal congestion that was caused by the medicine, not the illness. Additionally, young infants have gotten very sick or died after nasal decongestants because they developed respiratory distress due to the "rebound" congestion after the drug wears off. I don't object if a child over 12 wants to use a nasal decongestant before bed for three with a cold. 

Thanks for writing. My previous answer addressed the dangers of using cold medicines in babies. As far as Ludens drops go, anything that coats the throat and makes a child feels better is okay to try. Afterall, there are few side effects to a throat lozenge as long as the child is sitting down while sucking on it, i.e., to reduce the chances of a choking hazard.

Colds are very contagious. At home and school, the best thing to do is to have people wash their hands (before eating, when they come home from being outside, after blowing their noses, etc.) and cough into their elbows. However, even with these precautions colds will spread and you shouldn't feel guilty if one of your kids gets a cold or gives it to someone else. As someone said earlier, colds are a part of life.

Tea and honey are safe, and who doesn't want a foot rub?

Thanks for your input. Parents can get additional information on colds and other pediatric problems by going to the CDC website or the parenting website of the American Academy of Pediatrics: www.healthychildren.org. 

Expectorants are supposed to loosen mucus so it's easier to expel from your boby. Two products that puport to do this are plain Robitussin (for children), which contains a low dose of guafenesin and Mucinex (for teens and adults), which contains a higher dose of guafenesin. Plain Robitussin doesn't work at all. The research on Mucinex is mixed.

Cough suppressants are supposed to stop or reduce the cough by their effect on the "cough center" in your brain. The only OTC cough suppresant is dextromethorphan hydrobromide. Again, the research doesn't support claims that it works. Codeine will often suppress a cough, but narcotics have side effects that are unacceptable in most cases.

Alcohol can cause hypoglycemia (low blood sugar) in children, which can cause a seizure. So I'd recomment tea with honey instead.

I mentioned codeine earlier, but didn't get into the side effects in detail. I suspect you were given the codeine to make you sleepy. The problem is that a child could also get delirious or develop respiratory problems because of dosing errors, etc. 

I will sometimes use a mild codeine-like drug in older children with a cough, but only after I have listened to their lungs and made sure the benefit outweighed the risks. You can't do that with OTC medications.

I don't because most homeopathic remedies don't have research to back them up.

Ibuprofen has anti-inflmmatory properties, but when used for colds and the flue, it is the pain-relieving aspect of the medication that is important. 

I doubt that it works, which is why I made the comment, "who wouldn't like a foot rub?"

With young children, it's the parents observations that are taken into account. In the group under six age, active medication does not trump placebo.