We’ve entered that time of year when many of us try to stay indoors as much as possible, cringe at the mere sound of someone coughing, and stock up on hand sanitizer in attempts to ward off illness. Cold and flu season has begun and, as usual, our children are the most susceptible to these viruses.
As the father of two, I know that parents want to ensure that our kids are healthy and happy, it’s in our nature, so when our kids become ill, we want to fix it immediately. But are the cough and cold medications you find overflowing in the aisles of your pharmacy the best option for easing your child’s symptoms?
As a pharmacist I speak with parents all the time who grab a bottle of cold medicine off the shelf that makes the most promises of relief on the label. If the parents seek my advice I often tell them it would be wiser to put the bottle down and offer their kids comfort measures at home like warm soup, a humidifier, and lots of fluids instead. I know this seems counter-intuitive – I’m a pharmacist! Most people assume I see medication as the solution to every problem. Not so.
First, it’s important to note that over-the-counter cold and flu medications can’t cure or shorten the duration of those illnesses, they can only offer temporary symptom relief while the virus runs its course. The infection and symptoms will end when the child’s own immune system has won the battle. When our body is fighting off an infection like a cold, our immune system mounts a heroic response to the virus. In fact, the most annoying symptoms of a cold (coughing, sneezing, runny nose, low-fever) are signs that our body’s immune system is doing what it’s supposed to. The body’s immune response is so powerful that many over-the-counter cold and flu medications can’t and don’t effectively mitigate the symptoms.
Further, these medications, in addition to their limited effectiveness, have a high potential for adverse effects. Due to the low benefit and high potential for adverse effects, in 2007, the FDA disapproved over-the-counter cough and cold medicine (CCM) use in children under 2 years of age.
Again, it’s normal for parents to want to ease their child’s discomfort when they’re sick and many parents have admitted to me that they take liberty with the dosing guidelines on the medication packages because their kids aren’t experiencing symptom relief from the medication. Some have said they either double or triple the recommended dosages or increase the frequency beyond the guidelines. Many children already experience adverse effects when taking CCMs at the recommended dose. So overdosing a child on cold medication, and also measuring it imprecisely or heavy-handedly with spoons is not only dangerous, but potentially deadly.
So, if the medications aren’t effective, what’s inside them that can be harmful? Most of the CCMs contain the same ingredients: a fever reducer (usually acetaminophen), a cough suppressant (dextromethorphan), and/or an antihistamine to treat runny nose or sneezing (typically diphenhydramine). I’m going to discuss the ingredients in them one by one:
A disturbingly high number of CCMs contain acetaminophen as a fever reducer, despite the fact that many children do not experience fever with the common cold. Additionally, because acetaminophen is so ubiquitous in CCMs, it is common for parents to accidentally overdose their children when they administer additional medications along with it. I’ve counseled many parents who have mistakenly given their sick children both a CCM and Tylenol (both containing acetaminophen) at the same time and never realized their error. The symptoms of acetaminophen overdose include vomiting, convulsions, and coma.
Dextromethorphan is the most common cough suppressant available over the counter. Studies in children show that this agent provides neither a benefit in suppressing cough nor calm the cough enough to improve the quality of sleep. Adverse effects include dizziness, stomach discomfort and, at high levels, disturbances in the level of consciousness.
Antihistamines are incorporated in CCMs to improve nasal symptoms or to act as a cough suppressant. There is substantial evidence showing the effectiveness of antihistamines in the treatment of allergic rhinitis and calming down a runny nose, nasal congestion and sneezing. However, this is not the case when dealing with a child suffering from a cold.
Some parents hope to avoid these risks by using medications that are marketed as “natural” or “homeopathic.” This category of CCMs has grown dramatically over the past few years and they are no better than traditional CCMs and can be just as dangerous because their ingredients are not regulated by the FDA as they contain no actual medicine.
More important for parents to know, these products do not have to prove safety or efficacy in order to be produced. One of the more popular products that parents ask me about is Zarbee’s Naturals Children’s Cough Syrup. The beautifully designed box promises to soothe cough and irritated throats. The main ingredient is dark honey. Although, there is some evidence that honey has some benefit in calming down a cough, the studies available were completed with pure honey and not with Zarbee’s actual product, which contains honey that has been diluted. Even Zarbee’s website neglects to share the actual studies they used to support their claims.
Another popular brand, Similasan, markets their Kids Cough and Mucus Relief Syrup to address mucus, fever, cough, and congestion. One study demonstrated that one of the ingredients provided some benefit; however, Similasan’s syrup contains ingredients that have been diluted to near inert levels. Substantial scientific evidence proving the effectiveness of homeopathic or all-natural products is nearly non-existent or very difficult to find. Although, these remedies may not cause harm in most patients, they most likely provide no improvement when treating cold symptoms.
When a parent asks me what else they can give their child because they already tried three or four allergy/cold medications with little to no relief, they’re usually not pleased when I inform them that waiting it out is their best option. I’ve had sick kids before, so I know the strain and stress having a sick kid puts on a family.
Ultimately, the best ways to treat a common cold in children is to maintain a proper diet, blow their nose regularly to clear out infected mucus, stay hydrated, and get plenty of rest. Even with all of the choices that promise to assist in healing the cold, it is simply in our best interest to just let the virus run its course. In this case, time is essentially the best medicine.