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

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

View the Finding Relief for Your Cough Slideshow

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 that allowed one parent always to be at home is no longer the norm. Aside from not wanting your child to suffer, the practical considerations of adjusting day care, school, and work means adding more stress to life at home with an ill child. Instead of allowing a virus to run its course and the cold to resolve over a few days, billions of dollars are spent on advertising to let parents know that the symptoms of a cold can be controlled with hundreds of different over-the-counter cold preparations. Unfortunately, many of these drugs have significant side effects and may not be in the best interest of the infant or child.

Acetaminophen (Tylenol, Panadol) and ibuprofen (Advil, Motrin) are important drugs to use to control fever and pain in children, but too often they are bundled with combinations of antihistamines, decongestants, and cough suppressants that suggest an all-in-one cure for the symptoms of the common cold and other upper respiratory tract infections (URIs). Rows of store shelves are filled with dozens of 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.

First, the big warning.

enet.com/acetylsalicylic_acid/article.htm" rel="pharm" onclick="wmdTrack('embd-lnk');">Aspirin should never be given to infants and children because of its association with Reye's syndrome, a condition that can cause swelling of the brain and liver. In the United States, the Food and Drug Administration (FDA) recommends that aspirin should not be used in patients 18 years old and younger; the recommendations in the United Kingdom are that it not be used in those 16 years old and younger.

Second, another big warning. Acetaminophen can be toxic to the liver if too much is taken at once or over a period of a few days. The correct dose is always listed on the bottle, and it is important not to exceed the recommended amount. When in doubt, please ask the pharmacist or a health-care provider. And it's important to remember that the amount of medication required is based on the child's weight and not on their age.

Third, still another big warning. Just because it's available over the counter doesn't mean that a medication is safe to use in all situations. Many cold medications depend on stimulants to shrink membranes and decrease nasal secretions. Phenylephrine and pseudoephedrine look like adrenaline to the body. Antihistamines, like chlorpheniramine, brompheniramine, and diphenhydramine (Benadryl), can cause sleepiness (they are the active ingredient in many over-the-counter sleeping pills) but also may result in agitation and hallucinations.

With so many choices on the shelf, one would think that cold medications actually work and are indicated in treating the symptoms of colds and runny noses. But not really.

  • The American College of Chest Physicians' policy is that cough medicines, including guaifenesin and dextromethorphan, do not work; they recommend that cold medications not be given to anyone younger than 14 years of age.
  • The American Academy of Pediatrics does not recommend over-the-counter cold remedies for children under 4 years of age.

Unfortunately, government regulatory agencies move at a snail's pace when making their recommendations. The FDA issued a public-health advisory about the use of cold medications in kids in August 2007, warning of potential dangers of these medicines to children under 2 years of age. But even this recommendation can be confusing, since most pediatric medication dosing is based on weight, not age. How much different is a child who is 2 years and 1 month old (25 months old), compared with an infant who is 1 year and 11 months old? At the time of the recommendation, the FDA was "committed" to studying the medications in kids aged 2-11 and praised drug companies for voluntarily printing on their labels that these medications should not be given to children under 4 years of age. It is now 2016, and the FDA is still studying the safety of cold medications in the pediatric population.

The bottom line is that infants, toddlers, and chil

dren get colds, they get cranky, and they can be miserable. Parents suffer along with their kids and want to be able to make their child feel better, and that is not always easy. Drinking fluids, controlling fever with acetaminophen and ibuprofen, humidifying the air and hugging your child are all appropriate treatments and come with few side effects. And at the end of the day, a tincture of time may be the best remedy of all.

Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics

REFERENCES:

American College of Chest Physicians. "Patient Information for Parents of a Child With Cough."

Consumer Healthcare Products Association. "Makers of OTC Cough and Cold Medicines Announce Voluntary Withdrawal of Oral Infant Medicines." Oct. 11, 2007. <http://www.chpa.org/10_11_07_InfantCC.aspx>.

"Cough and Cold Medicine -- Not for Children." American Academy of Pediatrics. A Minute for Kids. WBBM-AM, Chicago, IL. 2015.

Fashner, J., et al. "Treatment of the Common Cold in Children and Adults." Am Fam Physician 86.2 July 15, 2012: 153-159.

United States. U.S. Food and Drug Administration. "Nonprescription Cough and Cold Medicine Use in Children." Aug. 15, 2007. <http://www.fda.gov/Drugs/DrugSafety/DrugSafetyPodcasts/ucm078927.htm>.


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Reviewed on 4/11/2016

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