Cold and cough medicines for youngsters a no-no | by Keri Mitchell

Posted on Thu, Jun 5, 2014

Dr. Brian Gablehouse often gets the plea in the middle of the night: “Please tell me what I can do for my baby’s cough,” a worried and sleep-deprived parent begs over the phone. Unfortunately, if the child is 6 or under, Gablehouse’s answer is: Not much.

“I know waking up is not very much fun, but for the most part, the cough is what’s keeping the goo out of their lungs. It’s a protective reflex,” says Gablehouse, a pediatrician with Peak Pediatrics in Wheat Ridge and Thornton. “Over-the-counter cough medicines are not effective and might put them at high risk for pneumonia,” Gablehouse says, referring to the serious illness that can result if the “goo” settles in the lungs. “In small kids, if they need to cough, they need to cough.”

In 2008, the Food and Drug Administration recommended that over-the-counter cough and cold medicines never be used in children younger than 4, and that 4- to 6-year-olds should use these medicines only with a doctor’s supervision. The recommendation was based on a review of a number of cases involving a range of serious side effects in children using these non-prescription drugs.

First do no harm

This shift in treatment can be a hard pill for parents to swallow, so when Dr. Tom McCall, a pediatrician at Arapahoe Park Pediatrics in Littleton, breaks the news, he explains that studies of cold medicines in children have also not proven them to be effective. “If these things can’t be proven to do anything, and every now and then they cause harm, why are we recommending these at all?” McCall says.

For a cough, some evidence suggests that vapor rubs can be helpful for children 3 months and older, and a teaspoon of honey for children 18 months and older can help (giving honey to infants can cause botulism, a serious and disabling disease). Squirting saline drops in the nostrils also can benefit babies and toddlers struggling to eat or breathe because of a cold, McCall says. “It’ll just kind of soften things up.”

A bulb syringe can be used to suck mucus from the nostrils, but frequent use might cause more irritation with baby than it’s worth, McCall says. Trying to convince a toddler to blow her nose is another battle McCall says isn’t worth fighting. “Let them snort it up,” he says. “They don’t need to blow it out.”

Signs of trouble

No matter what parents do, a cold typically means seven to 10 days of a runny nose, cough and sneezing. If symptoms last longer than two weeks, that’s a reason to visit your doctor, McCall says. Another is symptoms that seem to be clearing up but abruptly worsen — a child’s overnight coughing escalates, a baby is up all night fussing — or if fever spikes after a few days. “A cold, if it’s going to have a fever, is going to have it at the beginning, not at the middle or the end,” McCall says.

Watch for signs of serious breathing troubles, such as breathing rapidly or sucking in the chest with breaths, and dehydration, such as chapped lips or crying without tears, Gablehouse says. “Those things are not OK. Those are things you need to call your doctor for in the middle of the night. Wake us up.”

The good news is that most children afflicted with a cold “are happy, play normally and sleep peacefully,” according to the American Academy of Pediatrics.

“Kids are going to get sick, especially young kids,” Gablehouse says. “Basically from September until March, they’re going to have a snotty, runny nose, and it doesn’t mean anything’s wrong with the child. That’s the norm.” McCall agrees: “The kids are fine. It’s just hard on the parents.”

Tags: cough, medicines, pediatrician