When a child comes down with a cold, many parents head straight for a bottle of children's cold medicine. Don't bother.
A common cold is the most frequent illness people get with more than 200 viruses causing these infections. Older children and adults get two to four colds per year; young children get them six to 10 times a year. Because colds are more common during the school year, some kids will get a cold every month between fall and spring.
It's worth it to give children lots of fluid, acetaminophen or ibuprofen if they are uncomfortable and liberal doses of books, games and TV. But research has repeatedly shown that cold medicines don't work for children younger than 6, and they provide only a negligible benefit for those 6 to 12.
A 2012 review by the Cochrane Collaboration, which looked at many studies done on the effectiveness of over-the-counter cold medication, reported that while antihistamine-analgesic-decongestant combinations provide some help to adults and teenagers, there is no evidence of effectiveness in young children. Even for teens and adults, the review found that the adverse effects experienced when using cold medicine need to be weighed against the benefits.
Children are more likely to develop a fever with colds than adults. Nasal mucus turns from clear to yellow or green by the second or third day of the illness. Sleep may be interrupted, especially in babies and toddlers. Symptoms typically resolve by seven to ten days, but may last for two or three weeks. Contrary to what many people believe, discolored nasal mucus usually does not require antibiotic therapy.
Even though cold medicines for children don't work, most come with labels promising relief for many of the symptoms that accompany the illness. Let's look at the evidence.
One of the main ingredients in cold medicines are antihistamines. Histamine is a chemical released by the body if a person is allergic to things such as pollen or animals. Histamine causes blood vessels to swell, which in turn causes nasal congestion, runny nose, itchy eyes and cough. Antihistamines work by blocking the effects of histamine.
It's been shown in adults that histamine is released by some of the viruses that cause colds. As a result, antihistamines help to dry nasal secretions with certain colds.
There are lots of blood vessels in the nasal and sinus passages. Cold viruses create inflammation that causes blood vessels to swell, thereby narrowing the passages that bring air into the body. Decongestants are designed to reverse this process. Although there is evidence that decongestants work in teens and adults, the same thing isn't true for younger children.
Nasal passages are lined with hair and a thin layer of mucus. Sinus cavities contain mucus and tiny hair-like projections called cilia. These components are designed to trap viruses, bacteria and foreign matter.
When you catch a cold, the body's immune system responds to fight the virus. One aspect of this battle is an increased production of mucus. At some point, there is so much mucus in your nasal passages that you can't breathe through your nose.
Expectorants are supposed to thin mucus and make it easier for you to expel it from your body. Research in adults showed mixed results on whether mucus thinners were effective. There is no evidence that they work in children.
Coughing is a protective reflex designed to keep liquid and solid material out of your lungs. Research has shown that cough suppressants in children and adolescents are no better than placebo. Interestingly, new research has shown that honey may reduce the coughing that accompanies a cold. (Honey should never be given to a child younger than 12 months because it could cause infant botulism.)
Zinc, herbals and Vitamin C
Zinc slows replication of some of the viruses that cause colds. In doing so, it can shorten the course and severity of a cold. Research has shown that zinc is effective with adults, but the data are insufficient to recommend its use in children.
There are mixed results concerning the effects of Echinacea and Vitamin C on cold symptoms in adults. There is no definitive evidence that they help children.
The most common side effects of cold medicine include drowsiness, nausea, abdominal pain, irritability and dizziness. Less commonly, a person may experience tremors, a rapid heart rate and elevated blood pressure. In rare circumstances, convulsions and death have been reported with the use of these medicines, particularly in children less than two.
In 2007, the FDA recommended that cold medicines should not be given to children younger than 2. At the time, the agency supported the actions taken by many drug companies to voluntarily stop selling cold medicine for this age group. The FDA is currently reviewing its policy on the use of cold medicine in older children.
Treatments that help
Vaporizers and cool-mist humidifiers moisturize the air in a room. They have no direct impact on the symptoms of a cold, but dry air can make a sore throat feel worse. Hot-air vaporizers that create steam should not be used around children because they boil water. If a child accidentally knocks over the vaporizer, it could result in a serious burn.
Saline (salt water) in the form of nose drops, sprays and solutions can also provide temporary relief in some people even though they don't shorten the duration of a cold. However, many children hate having anything put in their noses, and fighting with them to instill drops or sprays could lead to a bloody nose and worse congestion.
No one has proved that drinking fluids loosens mucus or makes a cold resolve more quickly, but it's common sense that keeping a child hydrated will make him feel better. I read a study years ago, which showed that chicken soup loosened nasal mucus in adults. It has never been studied in children, but generations of grandmothers (mine included) have been firm believers in the medicinal value of chicken soup. I may be a doctor, but I'd never argue with my grandmother!
Originally published in the Washington Post