Cold medicine for a sick child? Don't bother.

Jan 15, 2013

Research shows that cold medicines do little, if anything, to treat the colds of young children - a surprising and frustrating revelation for most parents.

Pediatrician Howard J. Bennett reviews the ingredients in cold medicine, and their side effects in Tuesday's Health and Science section. "The truth is, a cold has a predictable life span, and not much can be done to interrupt it," he says.

What can parents do about children's cold symptoms? Bennett answered questions on Tuesday, Jan. 15th.

Welcome to today's chat about cold symptoms in children. Let's get started!

I noticed that most cold medications are not recommended for children under the age of 6. So other than giving them medicine to control a fever, what else can they take to relieve cold symptoms, especially congestion? My son gets pretty miserable when his nose is clogged up, then he has to breathe threw his mouth while trying to keep the binky in at the same time. And of course he hates the saline solution and sunctioning!

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. 

I just wanted to say thank you for your article. My 9 month old son just got over his first cold and I felt so bad that I couldn't do much for him besides some baby Advil and put a humidifier in his room. I made him chicken soup and breast milk but he didn't want to eat much solid food. A couple of times he coughed so hard that he vomited. He seemed cheerful and went back to playing after but is there anything that I could have done to help avoid the vomiting?

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.

What temperature is appropriate to give a child a fever reducer vs. letting it "run its course"? And is giving said fever reducer going to prolong the recovery process?

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.

I consider cold medicine to be anything I might take when I am not feeling good. This isn't limited to when I have the cold or flu. Have a headache, seasonal alergies, upset stomach, or a cough, take something from the medicine cabinet. Are you saying that all of these are useless for kids or just the ones that are supposed to treat colds (and the flu)?

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.

How about mustard plaster, cod liver oil? My mother used to use those cure-all tortures on me when I was a child with a cold.

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.

What can I give my two-year-old daughter to provide some relief for her constant cough? She also has a runny nose and watery eyes. No fever yet. Appetite seems ok. But the cough is keeping her up at night and is distressing for her. I have kept her home from preschool today, but hope to send her back soon. She and I thank you!

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!

 

I think that most of the medicine for a common cold treats the symptoms only...that being said, I find that as common a condition as a cold is, the symptoms are far more annoying, make the kid uncomfortable and most importantly, interfere with their breathing in the night. Any effective cure for that?

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.

One question I had about the article - were children not studied in the investigations of cold medicines? So we don't know if the medicine is effective or not? Or were the children studied and the results showed that the medicine wasn't effective?

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.

In our experience, OTC medicines for children seem to be about relieving symptoms, and we've typically used Motrin or Tylenol. Has that been your own experience? One of our children is sensitive to food dyes, with abdominal cramps and mood swings, and sometimes the dye-free versions of the meds are difficult to find.

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.

So what can you give to your child to help them in dealing with a cold?

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

Your article is full of great information - thank you! For me, the most bothersome cold symptom is coughing fits. I will try honey, as you suggest. My usual remedy is to take something that dries the sinuses so it gets rid of post-nasal drip - is there anything wrong with that?

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.

My 22 months son, started crying before nap/ bedtime...this started a few days ago and it goes on for 40 minutes or so. When one of us stays in his room, he is fine as long as we are there. He is totally fine, no fever, no cold. Bed/crib is fine. What do we need to do to stop this?

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.

I have been preaching to anyone who will listen about the pointlessness of cold medicine for years. Why short-circuit your body's own immune system responses to a cold (runny nose, slight fever, cough)? You may get some short-term relief from the symptoms, but doing so will just make the cold stick around longer. All I use is Vick's and an anti-histamine to help me sleep (they work for me), along with as much rest and fluids as I can get, and my colds are well on their way within about three days. Besides, is it really such a good message to give children to immediately take a pill whenever they feel uncomfortable? Because that's all a cold is - uncomfortable - and kids need to learn that these things happen, but they pass.

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.

My kids are in middle school now, but back in day, you could get pseudoephidrine in the infant drops. When their noses were absolutely blocked from a cold, we gave quarter or at most half-doses once or twice a day, because that stuff was so powerful. (As an adult, I take only a half dose.) That said, you could see it working, or at least we all felt it did. Heck, they clearly slept better after some time to let the drug kick in (though you will just tell me my kid got tired). So, what are you doing to prove parents wrong? Giving kids the meds in the lab and looking up their noses??

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. 

I'm a retail pharmacist who once physically blocked the children's cough section-the parents were determined to give cough medicine to their 6 week old to help him sleep. No amount of explaining that it was dangerous to their child and had no evidence of efficacy worked. One other thing that parents of older children (ie old enough for a cough drop) can consider is Ludens throat drops. They're made out of pectin so it's like sucking jelly. It coats a sore throat pretty well. Thanks for the article-it reinforces what we try to do everyday.

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.

Is there anything you can say about how contagious colds are? It's hard for everyone to be in the same house every day with the same people, but is it wise to risk play groups when we (or they) have been sick? Thanks.

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.

Herbal tea with honey seems to work really well for my two year old, and then I rub decongestant stuff on his feet which seems to help.

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

On behalf of the Consumer Healthcare Products Association's Educational Foundation, we wanted to highlight the need for educating parents on the safe use of these medicines. For decades, parents have relied on over-the-counter (OTC) medicines to treat their children's symptoms. What resources can you provide to parents on the safe use of OTC medicines? We remind parents that it is important to only give your child a medicine that treats his or her symptoms, to read and follow the label, and to speak to their doctors if they have any questions. Through our foundation's website, OTCsafety.org, parents can learn more.

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

I often see cough medicine that contains both an expectorant and a suppresent. I recently asked a pharmacist how that works having both together, and he said he'd always wondered the same thing. Can you give me a better answer than he did? Thank you.

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.

An old family cold "cure" was a mixture of honey and whiskey. I was given this as a child. What are the potential side effects of giving this mixture to a child?

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

When I was little my father was able to buy an OTC cough syrup that contained a bit of codeine, which would make me sleepy and stop coughing. Was there really in harm in that?

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.

Our daycare owner turned us onto to homeopathic meds, such as Hyland's, that you start giving your kids at the first sign of a cold. I wouldn't say that they have eliminated colds completely, but they do seem to be less severe. Do you ever recommend those?

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

I always assumed that the anti-inflammatory part was working on the swollen throat. Does that make sense? In any case, our kids always sleep better with a dose before bed if they've got a heavy cough.

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. 

Someone just said this " then I rub decongestant stuff on his feet which seems to help." So, rub Vicks vapor rub on a kid's foot and it will help??! This seems like the best kept secret if it actually works!

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

Thank you for taking my question. We used the oral drops, not the nasal sprays. We all avoid those, because we see how it has worsened symptoms. As for those studies, because these are meds for treating symptoms, not the cold, the relevant question is whether the child felt better, even if the cold still lasted 5 days. I was not saying that any of these meds makes anyone get over anything faster.

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.

I appreciate the terrific questions people asked during today's online chat. I hope the article and the chat encourages people to continue discussing colds and cold treatment and to avoid using medication that has not been shown to help children.

In This Chat
Howard J. Bennett
Howard J. Bennett is a board-certified pediatrician with thirty years of clinical experience and author of several books including, "Waking Up Dry: A Guide to Help Children Overcome Bedwetting." He was appointed director of pediatric education and won the first Outstanding Teacher Award given in his department. Bennett has had a private practice in the District since 1991. But continues academic affiliation as a clinical professor of pediatrics at The George Washington University School of Medicine.

Regularly listed as a "Top Doctor" in Washingtonian magazine, Bennett has appeared on a handful of national television shows, including NBC Nightly News, World News Tonight, and CNN. He also contributes to GreadDad.com and Jack and Jill magazine, and writes the Ever Wondered column published in the Washington Post. The column appears in KidsPost, which is published in the paper's Style Section.
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