“Which over-the-counter cough and cold medicine will work best for my child?” That’s a question I’m asked frequently in my practice. The answer, quite frankly, is none.
There has never been good evidence that cough and cold medications work. Moreover, for children under 2, there is the added concern that we don’t have reliable information about safe and proper dosages.
Two years ago, the U.S. Food and Drug Administration issued a warning about giving over-the-counter cough and cold medicine to children under 2 years old, following reports of “serious and potentially life-threatening side effects” in babies and toddlers. The warning came after a year of review prompted by reports from the Centers for Disease Control and Prevention that linked three infant deaths and hundreds of emergency-room visits to reactions from cough and cold products.
Risk of adverse and potentially dangerous reactions, including convulsions, increased heart rates and altered consciousness, are particularly high for the youngest children when they receive doses that are too potent or given too frequently.
Cough and cold medications labeled for babies and toddlers have been pulled from store shelves several years ago, but these products still remain in medicine cabinets today. And while the label may advise parents to consult with their child’s pediatrician about proper dosing, some parents fail to do so.
Although the FDA warning applied only to infants and toddlers, the agency continues to review research about its safety and effectiveness for children 2 through 11 years old.
I recommend that cough and cold medications not be given until children are older than 5 years old, and then only once at bedtime if it seems to provide symptom relief. Here are some non-medication approaches for child under age 2:
• Position infant or toddler upright to improve nasal drainage
• Use a bulb syringe to suck out any excess mucous
• Apply saline drops in the nose to loosen mucous
• Use a cool-mist humidifier
• For children older than age 1, a teaspoon of honey with tea may improve cough symptoms from colds. However, honey should not be given to younger children because of the risk of infant botulism.
The takeaway message is that nothing makes colds go away any faster. Over-the-counter medicine may mask the symptoms in some cases, but should never be given to children under age 2. For children 2 years old or older, we should be very careful.
Dr. Dennis Woo is a board-certified pediatrician with the UCLA Medical Group and a former chair of the Pediatrics Department at Santa Monica-UCLA Medical Center and Orthopaedic Hospital.
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