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The Cold Truth About Cold Medicines

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The Cold Truth About Cold Medicines

You might be surprised to find how many times pediatricians tell parents to not take medicine. On this blog, I’ve talked about how fevers generally don’t need Tylenol and how viral infections (and many bacterial ear infections) don’t need antibiotics. Let’s talk about another thing your child most likely doesn’t need - cold medication. 

As all parents know, kids get sick. They pick up a respiratory illness from daycare, the playground, school, or even during a playdate. They cough, get congested, feel crummy, and any parent wants to give their child something to feel better. But the cold truth is that the best home care for cold symptoms is humidified air, TLC, and time - with perhaps some acetaminophen or ibuprofen only if the child is feeling especially uncomfortable.

Cough medicines come in all colors, flavors, and combinations. Some of the basic ingredients are:

  • Antihistamines (like diphenydramine/Benadryl) are intended to reduce runny nose

  • Cough suppressants (like dextromethorphan/Delsym) are intended to suppress cough

  • Expectorants (like guaifenesin/Mucinex) are intended to loosen mucus

  • Decongestants (like pseudoephedrine/Sudafed) are intended to reduce stuffiness

For all of those, I say "intended to," because when it comes to children in the setting of a viral illness, cold medicines don't necessarily work as advertised or aren't particularly well studied in children. Let's talk about cold medications that contain one or more of those ingredients.

For the most part, traditional cold medicines aimed at children under four are now off the shelves, but the evidence indicates that they aren’t effective for children under the age of six, either. Above six, the evidence is still spotty, with an occasional study showing an effect of questionable clinical significance, others showing no improvement, and an overall a poor amount of research in children. 

What's the Harm in Trying?

It may seem harmless to try an OTC medicine - after all, you can get one at nearly any grocery store, pharmacy, or gas station. But they’re not without risk. Thousands of children are seen in emergency rooms every year for problems caused by cold medications, usually from accidental ingestions or overdoses.  Deaths have occurred as well. Accidental overdoses are common - the dosage or timing is misunderstood, or a parent uses a spoon that holds more than a true 5mL teaspoon. Or parents don’t realize the cough medicine contains acetaminophen, and they have already given a dose of acetaminophen for fever. 

General Tips on Cough Medicines:

  • Avoid entirely for children under the age of six.

  • Don’t jump to use them for children over six, because they aren’t particularly effective and can cause side effects.

  • If you’re thinking about giving OTC to your older child, call your child’s doctor first.

  • If your doctor advises trying an OTC medication for an older child, be extremely cautious about dosing. Make sure the product doesn’t contain ingredients like acetaminophen that you might be giving in addition to the medication. And measure in milliliters using a syringe, not in teaspoons!

  • Lots of alternative OTC cough remedies are available, but they are generally untested for safety or efficacy. In fact, because supplements are not regulated by the FDA, parents don’t even have a guarantee that they are getting the supplement that they paid for, much less that it works. I recommend avoiding such products.

  • There is weak evidence that honey can alleviate the symptoms of a cold a little bit. Honey should not be given to children under the age of 12 months because of botulism concerns but can be tried in kids older than that. The studies used a half teaspoon for 2-5 year olds, one teaspoon for 6-11, and two teaspoons for over 11 years of age. It’s not going to be a miracle treatment, but may help a little. There are honey-based alternative cough medicines out there, but no evidence that they are any better than honey alone.

  • Keep all medicines, including OTC medication, locked up or otherwise out of the reach of children. Never call any medicine (OTC or otherwise) “candy” or any kind of treat when you give it to your child, so they aren’t inclined to seek it when they don’t need it. Be upfront about the fact that medicines should only be taken when you are sick, and only the amount you need, otherwise they can be dangerous.

No one likes seeing little kids who don’t feel well. We all want them to get better and get back to being the rambunctious, adventurous, and carefree kids we know. But colds are self-limited; they ultimately get better whether your child has a cough medicine or not. If your child’s fever (over 100.4° F) goes on for more than two days, if mild cold symptoms suddenly turn harsher or last more than two weeks, or if other concerning symptoms appear, call and schedule an appointment with your child's health care provider.