Thursday, August 16, 2007
Dangers of cold medicine in toddlers
Parents of young children should never give cough and cold medicine to children under age 2, unless instructed to do so by a doctor. This is the gist of a new advisory by the FDA prompted by a CDC report that showed at least three deaths and 1,500 adverse effects in infants and toddlers as a result of taking these medications. Most of the time, the problem seems to be overdosing - either by simply giving too much, too often, or mixing medications with the same active ingredients.

Turns out these medications can have some pretty powerful effects on young children. They can interfere with the heart's electrical system causing an arrhythmia or constrict blood vessels too much causing hypertension. While most of these problems seem to be associated with overdosing, it is possible that a small percentage of kids have an adverse effect even at smaller doses.

Truth be told, a lot of pediatricians hardly ever recommend cold or cough medicines for children that young. The biggest reason is that it is unclear what dose is safe for kids under 2. It is also unclear whether these medications even work. Instead, many doctors recommend using a soft suction tube to irrigate and suction the nose (a little disgusting, but pretty effective), saline nose drops or a humidifier.

If you are still going to use the medication, make sure to give it to your child exactly as prescribed and not to dose more frequently, even if it doesn't appear to be working. Use the measuring dispenser given with the medication, and if there isn't one, get one from the pharmacy. Never use adult-sized teaspoons or tablespoons to give the medication.

Children get colds - lots of them -- six to10 a year, on average. Almost always, they go away on their own. So, are you likely to go to the medicine cabinet if your child gets sick or do you let it run its course? What are some of the best remedies you have found?
Trust the science, not the scientist!

Problem is, the public is given too little science -- too little about OTC drugs, too little about stresses/strains on bridges, etc.

An example in my own experience is that my son was forced by an insurance co to switch from brand-name Pancrease to generic panocaps. About 2 years later, we learn that Panocaps are not as effective as Pancrease. Problem is that the enteric coatings are different, thus causing Panocaps to release too early and be significantly less effective.

Switching to Creon solved the mystery of why our son has been struggling the past couple of years--he improved immediately and is approaching where he was when on Pancrease!

Bio-equivalence of generics is not the same as clinical studies. We need more science!!
The hardest thing is me as a mom accepting that I can't do anything about a cold, other than just letting it happen. His doctors always tell me to wait the cold out, but I think that's harder on me than on my son, because I want to be able to make things all better for him, but I can't cure the cold.

The suctioning really does work to clear things up, especially with the saline first, and then waiting a few minutes, and then suctioning, and then more drops. It's gross, the first few times. But and I guess since he's 2, I've seen lot's of boogers, and I've gotten used to it.
Has anyone studied whether or not lead can cause, oh lets say autism? I watched cnn last week or so when they couldnot findout why autism is up 1 in 150 children diagnosed cnn said, something has to be helping it......
as a healthcare professional, i believe that doctors are pressured into prescribing certain meds from parents. for instance, antibiotics are way over prescribed in this country and pose a greater threat to children and adults than cold medicine.

most parents at least ask a health care provider(local pharmacy) when choosing an otc drug for a small child. the cough and cold products that contain a fever or pain reducer like tylenol cold and cough should never be used to treat any cough and cold symptoms due to the risk of tylenol overdosing.
Dear Dr Sanjay,
It is hard for parents to raise their children without having any disease. They often get injured and sick, and each time parents become disturbed. I recall both of my sons had a cold so many times when they were small. In most cases I didn't get them to a doctor and gave them a medicine from the pharmacy. Reading your article, I feel my sons might be lucky that they haven't suffered from serious diseases and severe adverse effects until today. Child-raising is just like a tightrope act in a way. Thanks for valuable information, and I'll tell my niece (who has three small kids) about your artcle.
Sometimes not giving cold meds is out of the question. I've found that keeping a small pad of paper next to our thermometer and cold medications work wonders...When calling our pediatrician's office, I write down the dosage and how frequently i can give it. Then I make a note on the same pad everytime I use a even if I forget, i can always look back and make sure that I am not overdosing and/or administering it too soon.
It is critical that healthcare providers instruct parents on how to properly pick and choose all OTC medications for children. Parents need to be aware of the active ingredients that these medications contain so that these adverse effects can be prevented. Parents make mistakes of mixing meds. not knowing that they contain the same active ingredients. It is also necessary for the parent to carefully dose the child with an adequate measuring device to prevent overdosing. As a nursing student I know how much people love medications, but sometimes looking for alternatives is the best way to go.
If that is the case, then shouldnt FDA be banning over the counter infant medicines like Little Colds, Infant Tylenol Cold, etc. ?

Nose pumps are good for suctioning the nose but what about cough, chest congestion. It will be helpful if Dr.Gupta can give some safe relief remedies for other symptoms that can help the little ones.

It's unfortunate, but I have heard of frequent misuse of these kinds of products in lieu of actual parenting, etc; the most frequent being (basically) drugging the children during car trips, flights, etc... sometimes enough of a dosage to keep them knocked-out for hours. It worries me. Are all of these parents getting lucky, or are we simply not hearing enough about children being treated this way?
I let colds take their course. But with a virus or infection that comes with a high fever, I will give my daughter some children's ibuprofin.

I've found it's the simple things that can lead to potential overdosing.

Remember to dose by weight, not age. My child is 7, but quite petite. It's easy to just go by the age recommendations for dosage, but I've found that when I double-check for weight guidelines, I could have overdosed her by giving the 'recommended' age-based dose. So it's worth taking a few extra minutes to weigh your child and then check the dosage by weight.

Also, confirm the maximum dosage per day. Even though the instructions say the dose may be repeated every few hours, if you actually gave the medicine that frequently you would be giving more than the maximum number of doses possible per day.

For example, the instructions may say the dose can be repeated every 6-8 hours, but no more than three times per day. But if you actually gave the medicine every 6 hours throughout the day, you'd exceed the allowable dose.

Simple considerations, but easy to overlook...
Looking at the numbers, it appears that the risk for children is probably the same as for adults who could potentially overdose on medications. However, it is definitely a more sensitive issue since parents are unintentionally causing harm rather than the children doing it to themselves.

While the thought of harming my own child has lead me to increase my threshold for administering cough and cold medications and using alternative means of relieving symptoms, there are certain things that only the medication can fix. Point in case being coughing throughout the entire night to the point where my son, nor I are able to sleep because he is miserable.

I have had great results with the plug in vaporizer device (PediaCare Gentle Vapors) and it has reduced his congestion, but the cough is the worse on him.

So....I CAUTIOUSLY give him cough and cold medication rarely to help him rest so he is not miserable that night nor the next day.
The following is a personal story relating to my family and should NOT be construed to be medical advice. You are advised to consult your family physician.

As a student physician and a parent of five, I know it's tough to not give medicine, as you want to do something palliative to reduce the suffering of your child.

The advice given by Doctor Gupta really is pretty good regarding humidifiers (in winter), Saline drops and NOT giving OTC designed for adults (A child's metabolism is essentially the opposite of an adults anyway and the effects of an OTC can be devastating).

I do recommend decent tea for my kids. (To break down the science of it briefly, there are numerous double-blind placebo studies that have proven the efficacy of the Pharmacokinetics of certain teas such as Pau d'arco, green tea etc. as it relates to fighting infection, reducing inflammation etc.)

Coughing is the bodies way of expelling the harmful so obviously I let my kids cough during the day, do not let them drink milk or other dairy products, push the lemon water and administer a mild (albeit natural) suppressant for sleep.

A little but of Vick's rub or Tiger Balm (which my son loves) on the chest to help with the sinuses seems to do the trick.

Ultimately, your child's body has to learn how to fight off infection and that's what the process of fighting a cold does.


Nick Donovan
Ft. Worth, TX
I think we should call "cold medicine" by what it really is "cold symptom releaver." Cold medicine doesn't do anything to "get rid of" a cold. Your body is still the reason a cold goes away. Cold medicine only releaves or temporary hides the symptoms associated with a cold. It'll make you feel better at work, but you are STILL sick and CONTAEGOUS.

Here's what I do.
-Only give a dose of tylenol when fever is above 101.5, otherwise just monitor. Did anyone tell you that fever is the bodies natural way of fighting off 99% of the bad stuff..
-Suction, many times, the symptom are a result from something inhailed and logged in the nose. A little saline relieves the SYMPTOMS and cleans out the nasial cavity.

Antibiotics should only be used for a BACTERIAL infection and your DOCTOR should tell you that.
As a mother of four, the oldest is alomost 9, and one has asthma which flares up with every runny nose I find that prevention helps colds and their symptoms from being as severe. By prevention I mean daily vitamins, homeopathic supplements for children, and alternative medicine treatments like reflexology. My children still get sick but seem to fight off the colds more easily.
I though cough syrup was gross as a kid so I generally avoided it unless someone (usually a doctor) made my parents give it to me. As I got older, I enjoyed heavily mentholated things like mint tea, altoids, peppermint oils to clear up my throat and nasal passages. I think cough syrup generally just represses symptoms, and those symptoms are a representation of the immune system fighting, not the virus winning.

Today when I get a cold, or feel one coming on, I make a batch of echinecea-lemonbalm tea. While echinecea's effects are disputed, it tastes nice in a tea, and if by some chance it does something, then thats great. Lemonbalm has been shown in a few studies to have antiviral properties (it was tested on the herpes virus) so I'll add that to my tea as well. Goldenseal is an excellent expectorant, so if the cold feels lower respiratory and phleghmy, I use that in small doses. If I've got congestion, mints provide some relief from that. For a sore throat, there are two simple remedies. Gargling either warm saline solution, or warm saline mxed with cayenne pepper (or any source of capsacin) usually provides some relief. Capsacin is a good antibiotic, it also irritates the back to the throat nicely, which provides extra bloodflow to the area. Saline is a natural disinfectant. The best and most surprising solution to a sore throat I've found is licorice root. A fine powder of this root can be shaken into an emulsion with the air in a small bag. Inhaling that emulsion does several things. First, it tastes very nice (sweet, with a very slight anise flavor), second, it coats the throat and helps to soothe the sore feeling, and finally, any of it you get into your lungs is an antispasmodic. Licorice root contains glyzherrinic (sp) acid, the basis of many modern asthma medicines.

Since it's hard to sleep while congested, I try to get myself to sleep using valerian root tea. Valerian is a powerful sedative, and should be used with caution, but it can be a great way to get some well needed deep sleep while sick.

As for kids, I don't think anyone should give powerful herbs to a kid with a little cold. Some mint tea, maybe with a little licorice root or chamomile in it is a good idea. What kids need more than anything when they're sick is lots of fluids and sleep.

When the cold turns into a flu, or something more deep seated and serious, I definitely call the doctor. The herbs are good for minor ailments and complaints, but it's good to know that more powerful drugs are available if needed.
I would like to see health care professionals and others who prescribe for children to tell parents to use only products that have one drug in them. Only ibuprofen, acetaminophen, one decongestant, one anti-histamine. The cocktails that are sold as cold or flu medicine have more than one ingredient and your child probably doesn't need all 3 or 4. Only administer the actual medication they need. Like some of the other comments; maybe use some of the teas with the ibuprofen. Maybe only a decongestant. Be stingy with your dosing. Buy only single drug liquids and use the actual one your child needs. It's amazing what is in those bottles for kids! It costs more but you only give what is needed!
I was disappointed to read a news article that all infant cold and cough medicines are being pulled from the shelf. The CDC report for 2004/2005 indicated 3 deaths in children under two and in all cases as a result of overdose and in multiple cases a combination of OTC and Prescriptions. There were over 1500 cases where serious adverse reactions had occurred, but I did not read what the cause was attributed to (medication or overdosing).

It is obvious that infants and children are more easily affected by medications and caution must be taken when they are administered.

My wife and I have successfully given cold and cough medication to our daughter, now 11 months with what I would describe as good results. Her cough was reduced and drainage seemed to increase. We have only given her medication when her cough has affected her sleep or stuffyness has affected her ability to eat. We always check with each other before giving medication and never give more frequently than 4-5 hours between doses. Also, our daycare provider does not medicate without very specific instructions, amount and time (i.e. .4mL at noon), but we have rarely done that.
As a parent of 2 1/2 year old twins who did get the average 10 colds a year, that is about one a month, each cold lasting about 2 weeks in duration. That means without something to help them sleep, they would have gotten very little sleep in the first year and half of their lives. Which would have put them more at risk for even worse infections, in addition to the real danger I may have harmed them from severe chronic lack of sleep. It's ridiculous to state children will get better on their own, of course they will. I hope most people realize these medications don't "cure" the cold, they just help everyone get through them. If these medications are not safe or effective, then someone needs to develop something that is, besides bulb syringe and humidifer. I tried just bulb syringe and humidifer with first cold and had to do it about every two hours, with two babies again no sleep for anyone. I am a nurse, and I know most doctors have given their children something to help them sleep during colds, because of course they have to work and be alert the following day. I fear for what "homepathic" remedy parents are going to turn to once these medications are off the shelves. This will be intersting.
I have 2 children under 4 years old. The older one can probably take "childrens" but the younger cannot.

The medicine does work to eliminate the symptoms, without it these children are not going to get much sleep. Not only making them miserable but us as well.

Our oldest is in 2 preschools, tap, and a playgroup, she is literally sick every other week. I'm not going to let my child suffer for 2 weeks out of each month.

Here's what's going to happen... Adults will see the children's medication, notice that it is exactly double the concentration of the "infants" and then start making their own meds. Stupid I know right? Well so is pulling a whole class of medication saying it "doesn't work" or is averse for a few thousand kids... Statistically insignificant for how many actually benefit from the meds.

Far more children get hurt tripping over their shoelaces than from this medication.

Why make parents have to come up with their own solution, just put the proper droppers or whatever these overdosing idiots need, and be done with it. The meds do help with the symptoms, now the only thing that's going to help is a nice expensive trip to the ER for that child that's out of their mind tired because they can't get any rest. You can hit your head with a hammer too... no reason not to sell hammers.

Great job!
After living in Japan for almost 14 years where it is legal and acceptable to purchase medicines for children under the age of 2, it is rather interesting for me to return to the U.S. to find the same practive unacceptable. These cold medicines are able to be purchased over-the-counter and are divided by symptoms, age, etc. just as you would expect in the U.S. If a customer was not sure which medicine was best for his/her child, then the pharmacist for the market could be asked and they were qualified to give advice on which product was best for the child. This system seems to work rather well, so I have a hard time fathoming why we cannot have the same medicine (and/or system)available in the U.S.

Just a thought....
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