Helping Children

Some Topics

Coughs, Colds, Respiratory Tract Infections

Children develop upper respiratory tract infections several times a year. About 80% of these infections are caused by viruses, which run their course regardless of what medications are offered. The prescription of antibiotics to treat cold symptoms is one of the more futile actions of MDs, responding to patient demand Most cold suffers use over the counter cold and cough pills and syrups that have little or no benefit Prescription cough medicines are of limited to no value and can be harmful.

The common cold is the most prevalent form of viral infection caused by viruses such as rhino and corona viruses. More virulent virus such as influenza and adenoviruses can begin with cold symptoms and progress to involve the lung in patterns of inflammation that may involve bronchi (bronchitis), bronchioles ( bronchiolitis) or alveoli (alveolitis, a.k.a. pneumonia)

The symptoms of URI make life miserable for up to 10 days. Nasal congestion is the main symptom of the common cold. Nasal congestion can be more distressing than cough or sore throat, since it compromises breathing. Congestion in infants interferes with feeding, since infants must breathe through their noses while breast-feeding. Adults can clear their nose by blowing, but infants are unable to clear the nasal airway on their own.

Kogan et al surveyed parents, for example, that 53.7% of parents of three-year-old children had used over the counter (OTC) medications for their child in the month prior to the survey. Seventy percent of recent episodes of URI had been treated with OTC remedies, often containing acetaminophen, a drug that has no value and that may be harmful.

The American College of Chest Physicians concluded that cough medicines do little good and may harm children. Paul et al tested two popular drugs, often included in cough medicines: dextromethorphan (DM) and diphenhydramine (DPH). The authors concluded that "Diphenhydramine and dextromethorphan are not superior to placebo in providing nocturnal symptom relief for children with cough and sleep difficulty as a result of an upper respiratory infection… the medications given to children do not result in improved quality of sleep for their parents when compared with placebo.” The authors also warned that both dextromethorphan and diphenhydramine have potential for toxicity. For dextromethorphan, adverse effects may include dystonia, anaphylaxis, bullous mastocytosis, dependence, psychosis, mania, hallucinations, ataxia, somnolence, type 1 diabetes mellitus, and death from high doses, particularly when combined with other over-the-counter (OTC) medications. Dextromethorphan is also a drug of abuse among adolescents. Adverse effects of diphenhydramine include somnolence, restlessness, nervousness, insomnia, dystonia, prolonged QT interval, seizures, and death.

In The USA and Canada, 800 cough and cold products are sold to treat children's viral illnesses, containing about 40 drugs, costing $500 million USD every year. Sept 2007: Harris reported that safety experts for the US Food and Drug Administration urged the agency on Friday to consider an outright ban on over-the-counter, cough and cold medicines for children under 6… the agency may take strong action against the roughly 800 popular medicines marketed in the United States under names like Toddler’s Dimetapp, Triaminic Infant and Little Colds. The reviewers wrote that there is little evidence that these medicines are effective in young children, and there are increasing fears that they may be dangerous. From 1969 to 2006, at least 54 children died after taking decongestants, and 69 died after taking antihistamines, the report said. And it added that since adverse drug reactions are reported voluntarily and fitfully, the numbers were likely to significantly understate the medicines’ true toll."

Regardless of what the US FDA decides, parents should abandon the belief that cold and cough medicines are effective and should be aware that they can be harmful, especially if the drug effects are combined by used more than one OTC product or combined with caffeine beverages and stimulant prescription drugs.

See Children and Prescription Drugs and Avoid Stimulant Drugs

The best strategy for children with colds and cough is to offer a pleasant cough syrup that is composed of sugar and flavoring without any harmful drug content. For older children and adults a topical nose decongestant used only for a few days may be helpful. Topical nasal decongestants can be a special problem for children under 3 years of age and are best avoided

A nasal aspirator can relieve nasal congestion in infants and young children. The aspirator is a flexible bulb with a removable plastic tip. The tip is inserted into the nostril to be cleaned, and gently released. A gentle suction is applied each nostril sucking mucus into the clear plastic tip. If secretions are too thick to be removed by this method, a non-medicated, 0.65% sodium chloride solution can be dropped or sprayed into the nostril. (Baby Ayr, Ayr Saline Nasal Mist, Breathe Right Saline Nasal Spray). The salt water solution will liquefy secretions that can then be removed with gentle suctioning.

Topical nasal decongestants, include nasal drops and sprays. The main agents are levmetamfetamine, naphazoline, and propylhexedrine. Pseudoephedrine and phenylephrine should not be given to children below the age of 6 years. They produce central nervous stimulation that interferes with a child's sleep and may raise blood pressure.

Ref: The Diagnosis and Management of Cough: ACCP Evidence-Based Clinical Practice Guidelines available online; accessed 01/2006: Pediatrics. 2004;114:e85-e90 Harris G. Ban Cold Medicine for Very Young. NYT September 29, 2007