Cold and Cough Medicine for Infants and Children - A Doctor's View

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Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Once upon a time, not so long ago, children were allowed to have runny noses and coughs. Colds were expected to last a few days and were considered an inconvenience.

But times have changed. The traditional family unit of one working parent and one at home is no longer the norm. Aside from not wanting your child to suffer, the practical considerations of adjusting day care and work - means adding more stress to a home with an ill child.

Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are important drugs to use to control fever in children, but too often they are bundled with combinations of antihistamines, decongestants, and cough suppressants, suggesting an all-in-one cure for the common cold. Store shelves are filled with these over-the-counter medications that beckon parents to make life a little easier for their child. Yet, even in adults, these medications are less than helpful, and the side effects can be potentially deadly.

The Consumer Health Care Products Association, a group of companies that make these cold medications, pulled the drugs off the market in October 2007 "out of an abundance of caution." And while this will make good press, I am uncertain why the abundance of caution existed on October 11, 2007, when the FDA made their public health advisory announcement two months earlier on August 15, 2007.

The FDA advisory is a little confusing. They warn of the potential danger to children under the age of 2, but much of pediatrics is based on weight, not age. And how much different is a child who is 2 years and 1 month old (25 months old), compared with an infant 2 months younger (23 months old). I presume this is why the FDA is now studying the safety of cold medications for children under 6 years of age.

Aside from fever control, good hydration, and adequate humidity, there is little else to offer the cold sufferer, except time. Cough suppressants tend not to work and the American College of Chest Physicians recommend not using them in children under 14 years of age. Decongestants contain pseudoephedrine, a chemical that acts like adrenaline, and may cause children to become "wired". Antihistamines may be useful but can cause excessive sleepiness in children (remember that they are the active ingredients in over-the-counter sleep medicines), and some children paradoxically get agitated with antihistamines.

The bottom line is that children get colds and they get miserable. Parents want to make their child feel better, and that is not always easy.

References: American College of Chest Physicians, "Patient Information for Parents of a Child With Cough". FDA Public Advisory, "Nonprescription Cough and Cold Medicine Use in Children," August 15, 2007. Consumer Healthcare Products Association Press Release October 11, 2007 "Makers of OTC Cough and Cold Medicines Announce Voluntary Withdrawal of Oral Infant Medicines."