The cold medicine debate
Friday, October 19, 2007
• For more information on the FDA’s position on over-the-counter cough and cold medicines go to www.fda.gov.
Millions of children receive over-the-counter cough and cold remedies every year, but some medicines have been more harmful than helpful. In the last two years more than 1,500 children have visited emergency rooms for possible overdoses associated with those medicines.
More alarming, since 1969 there have been 54 deaths associated with decongestants and 69 deaths associated with antihistamines. Almost all of the children who died were under 2. Now the Food and Drug Administration has announced it will review the safety and effectiveness of these medicines in children and consider whether labeling should reflect possible dangers.
Too much medicine
At proper dosing levels these decongestants, antihistamines and cough suppressants appear to be harmless, but according to the American Association of Poison Control Centers almost one out of every six children gets too much. One reason is that multi-symptom cold relievers contain several different active ingredients. Only the most ambitious parents are likely to read and try to understand the effects of medications with complicated names such as pseudoephedrine, guaifenesin, dextromethorphan and phenylephrine.
A parent may not realize that a medication labeled for "cough and allergy" could contain the same ingredients as one labeled for "chest and nasal congestion." Giving them both together could lead to a dangerous overdose. Children under 2 seem to be more sensitive to the negative effects of these medications, putting them at even higher risk. If that weren’t bad enough, there is absolutely no evidence that cough and cold medications actually relieve symptoms in children. In fact, numerous scientific articles have shown no effect whatsoever at the currently recommended doses.
Most cough and cold medicines advise parents to consult their physician for the proper dose for a child under 2. But physicians don’t have clear dosing guidelines either, because these medications have not been well studied in young children. Doctors use their best judgment based on their own experience so two different doctors are likely to come up with two different dosing recommendations.
The confusion regarding the proper use of these medicines has led the American Academy of Pediatrics to support a change in the product labels to state that they can be dangerous and may not work.
Warning: Cold season ahead
Unfortunately, this new and disturbing information comes just in time for cold and flu season. Sniffles, coughs, runny noses and scratchy throats will affect millions in the months ahead.
During the next several months parents will often feel helpless to prevent these infections and desperate to treat them once they occur. There are ways to help your child avoid illness this winter and, if they do get ill, to keep them comfortable even without over-the-counter medicines.
Many parents wonder where their child catches the six to 10 colds the average child gets every year. It’s impossible to say, but there are some very good suspects—and at the top of the list are their own hands. That’s right, in most cases a child touches something that an infected person has touched and then touches their own nose, mouth or eyes. That’s all it takes and 12 hours to five days later, the symptoms start. What did they touch? A door knob, a grocery cart, a toy, money, a library book, the girl next door, the list is endless, but the key is that the virus must reach the child’s nose, mouth or eyes and that generally happens by the child’s own doing.
Another way to catch a cold is through the air. When someone with a cold sneezes or coughs, the virus floats in the air for a short time. If you happen to be close enough to the person to inhale the particles, you may catch their cold.
Teach your kids to keep their hands away from their faces and encourage frequent hand washing especially before meals. To avoid passing their germs to others, teach your kids to cough and sneeze into the bend in their elbow, not into their hands. Also, it’s best to stand at least three feet from someone with the sniffles. Doing just those simple things will significantly reduce the chance of catching a cold or passing one to others.
What you can do to help
If, in spite of your best efforts, your child does catch a cold he or she will be contagious for up to two days before symptoms start until about five days after their onset.
To keep your child comfortable, try these simple strategies. First, a fever can make a child feel very sick so just getting the fever down can help a lot. Fever reducers like acetaminophen (the medicine found in Tylenol) and ibuprofen can be dosed safely in children as young as 6 months old. Be sure to notify your pediatrician if your child has a fever since an office visit may be needed to be sure it’s nothing serious. For stuffy noses use saline (salt water) nose drops (available at any drug store) and a bulb syringe to loosen and remove mucous. If a cough is so severe that your child can’t sleep, you can lubricate the back of the throat with warm herbal tea or warm salt water and the cough will usually decrease. Also, sitting with your child in a steam-filled bathroom or placing a cool mist vaporizer at the bedside may help.
If you feel you must use over-the-counter medications, read the package to be sure you are not giving two medications with the same ingredients. Follow the directions on the box and use the dropper, dosing cup or dosing spoon made for medications. Never use a kitchen teaspoon to measure medicines. Do not use a medication if you are unsure how to give it. And never give medications to a child under 2 without your pediatrician’s guidance.
Dr. Lisa Thornton, a mother of three, is director of pediatric rehabilitation at Schwab Rehabilitation Hospital and LaRabida Children’s Hospital. She also is assistant professor of pediatrics at the University of Illinois at Chicago. E-mail her at firstname.lastname@example.org.