By Howard J. Bennett, special to The Washington Post
When a young child comes down with a cold — congestion, a scratchy sore throat and runny nose, maybe with greenish goo — many parents head straight for the drugstore for a bottle of children’s cold medicine.
It’s worth it to give children lots of fluid, acetaminophen, or ibuprofen if they are uncomfortable, and liberal doses of books, games, and TV. But research has repeatedly shown that cold medicines do not work for children younger than 6, and they provide only a negligible benefit for children 6 to 12.
I notice two reactions when I share this information with parents in my pediatric practice: surprise, because these medications appear to work, though that’s really just because cold symptoms naturally wax and wane throughout the day; and frustration that there isn’t a medicine to just make the cold go away.
A common cold is the most frequent infection people get; more than 200 viruses cause these infections. Older children and adults tend to come down with a cold two to four times a year; young children get them six to 10 times a year. This is normal and not a sign that something is wrong with a child’s immune system. Because colds are more common during the school year, some children will get a cold every month between fall and spring. So it’s no wonder that parents want to reach for a cold medicine.
But a 2012 review by the Cochrane Collaboration, which looked at many studies done on the effectiveness of over-the-counter cold medication, reported that while antihistamine-analgesic-decongestant combinations provide some help to adults and teenagers, “there is no evidence of effectiveness in young children.” Even for teens and adults, the review found that “adverse effects” sometimes experienced when using cold medicine, such as heart racing, drowsiness, dizziness, and nausea, needed to be weighed against any benefit.
The truth is, a cold has a predictable life span, and not much can be done to interrupt it. When a child starts to get a runny nose, sounds congested, and acts cranky because his throat hurts, you know a cold has settled in. The sore throat usually resolves in a couple of days, but it may be replaced by sinus pain, headache, muscle aches, a hoarse voice, and cough.
Children are more likely to develop a fever with colds than adults. Nasal mucus turns from clear to yellow or green by the second or third day of the illness. Sleep may be interrupted, especially in babies and toddlers. Symptoms typically resolve by seven to 10 days but may last for two or three weeks. (Contrary to what many people believe, discolored nasal mucus usually does not require antibiotic therapy.)
Given the recent surge in flu cases, it’s worth noting that, like a cold, influenza is a viral infection and that over-the-counter cold medications won’t work any better against it than they will against other respiratory illnesses. However, there are prescription antiviral agents (Tamiflu, Relenza) that can shorten the course and severity of illness if started promptly.
Even though cold medicines for children don’t work, most come with labels describing promising relief for many of the symptoms that accompany the illness: congestion, runny nose, cough, thick mucus, aches, and fever. Let’s look at the evidence.
One of the prime ingredients in many cold medicines are antihistamines. Histamine is a chemical released by the body if a person is allergic to things such as pollen, dust or animals. Histamine causes blood vessels to swell, which in turn causes congestion, runny nose, itchy eyes, and cough from postnasal drip. Antihistamines work by blocking the effects of histamine.
It’s been shown in adults that histamine is released by some of the viruses that cause colds. As a result, antihistamines help to dry nasal secretions with certain colds.
One of the side effects of the antihistamines used in cold medicine is sedation. Doctors sometimes recommend these drugs for their sedating properties — that is, to help sick children sleep. There are limited data to show this works. But in fact some children become agitated or develop other side effects on antihistamines, and that’s one of the reasons the American Academy of Pediatrics does not recommend using cold medication for its sedating properties.
The newer antihistamines found in many allergy medicines have no effect on the symptoms of a cold.
There are lots of blood vessels in the nasal and sinus passages. Cold viruses create inflammation that causes the blood vessels to swell, thereby narrowing the passages that bring air into your body. Decongestants are designed to reverse this process. They come as oral and spray preparations.
Although there is evidence that decongestants work in teens and adults, the same thing isn’t true in young children.
Nasal passages are lined with hair and a thin layer of mucus. Sinus cavities contain mucus and tiny hairlike projections called cilia. These components are designed to trap viruses, bacteria, and foreign matter. Cilia beat in sequence to propel mucus to the back of your throat, where it is swallowed. Most people are not aware of this, even though the average person swallows up to a pint of mucus every day.
When you catch a cold, the body’s immune system responds to fight the virus. One aspect of this battle is an increased production of mucus. At some point, there is so much mucus in your nasal passages that you can’t breathe through your nose.
Expectorants are supposed to thin mucus and make it easier for you to expel it from your body. According to a 2008 Cochrane review, research in adults showed mixed results on whether mucus thinners were effective, and there is no evidence so far to show that they work in children.
Coughing is a protective reflex designed to keep liquid and solid material out of your lungs. Research has shown that cough suppressants in children and adolescents are no better than a placebo. Interestingly, research published last summer found that honey may reduce the coughing that accompanies a cold. Presumably, it works by coating your throat and “calming” the nerve signals that produce the cough. Because there are no significant side effects to honey, it’s worth a try. (Honey should never be given to a child younger than 12 months of age because it could cause infantile botulism.)
Zinc, Herbals, And Vitamin C
Zinc slows replication of some of the viruses that cause colds. In doing so, it can shorten the course and severity of a cold. Research has shown that zinc is effective with adults, but the data are insufficient to recommend its use in children.
There are mixed results concerning the effects of echinacea and Vitamin C on cold symptoms in adults. There is no definitive evidence that they help children.
Whenever someone takes medication, it’s important to weigh the positive effects against the negative effects. The most common side effects of cold medicine include drowsiness, nausea, abdominal pain, irritability, and dizziness. Less commonly, a person may experience tremors, a rapid heart rate, and elevated blood pressure. In rare circumstances, convulsions and death have been reported with the use of these medicines, particularly in children younger than 2.
In 2007, the Food and Drug Administration recommended that cold medicines not be used by children younger than 2. At the time, the agency supported the actions taken by many drug companies to voluntarily stop selling cold medicine for this age group. The FDA is currently reviewing its policy on the use of cold medicine in older children.
So what’s the parent of a sniffling, congested child with an achy throat to do? Several steps can help make a child more comfortable as his or her body naturally sheds a cold.
Vaporizers and cool-mist humidifiers moisturize the air in a room. They have no direct impact on the symptoms of a cold, but dry air can make a sore throat feel worse. Hot-air vaporizers that create steam should never be used around children because they boil water. If a child accidentally knocks over the vaporizer, it could result in a serious burn.
Aromatic vapors have been used to treat colds for centuries, but few studies have been done to assess their effectiveness. A 2010 article in the journal Pediatrics showed an improvement in cough, congestion and sleep difficulty in children treated by applying a vapor rub containing camphor, menthol, and eucalyptus to their chests. (More than a third of patients had side effects such as skin redness or a burning sensation of the eyes, skin, or nose.) The study has been controversial, in part because the lead author was a paid consultant to a company that makes such a rub.
Saline (salt water) in the form of nose drops, sprays and solutions can also provide temporary relief in some people. There is no evidence that saline washes, which loosen mucus, reduce irritation and lessen dryness, shorten the duration of a cold. Keep in mind, though, that most small children hate having anything put in their noses, and fighting with them to instill drops or sprays could lead to a bloody nose and worse congestion.
No one has proved that drinking lots of fluids loosens mucus or makes a cold resolve more quickly. But it’s common sense that keeping a child hydrated will make him feel better. I read a study years ago that showed that among the best fluids is chicken soup, because it loosened nasal mucus in adults. It has never been studied in children, but generations of grandmothers (including my own) have been firm believers in the medicinal value of chicken soup. So the next time your child has a cold, walk past the cold-medicine aisle at the supermarket and pick up some soup instead.
Pediatrician Howard J. Bennett wrote this guest article for The Washington Post, published January 17, 2o13.