My good friend and pharmacist, Lindsay Spear, offered to write this little post to explain to moms all the recent hullabaloo about cough and cold medicine for kids. Hopefully the mystery will be demystified for you today!
Several weeks ago a good friend of mine called me at home to ask me about a topic that has confused many parents recently. She said “I know it is now illegal to give my baby medicine for her stuffy nose, but she can’t breathe and is miserable. What can I do?”
In January 2008 the FDA recommended that over-the-counter (OTC) cough and cold medications be avoided in children under 2 years old, and in October 2008 this recommendation spread to children under 4 years old as well. This has lead to many questions and much confusion among parents.
After being on the market for years, why did the FDA suddenly decide that OTC cough and cold medications are no longer safe in young children? What are the alternatives if I can’t give my child medication to help with his or her symptoms?
In essence, very little information exists that proves the efficacy of cough and cold products in children. Children are not “little adults.” They metabolize and excrete drugs differently than adults and have differences in lung anatomy and immune-system response. Also, it is very difficult to study drug efficacy in small children because they can’t communicate improvement or worsening of symptoms.
The limited data that is available looking at cough and cold medication use in pediatric patients is not impressive and shows very little benefit. Although OTC cough and cold medications are safe in most children when used appropriately, the products are often unintentionally misused leading to serious side effects or death.
Examples of misuse include:
- Giving a child multiple products with the same active ingredients, leading to overdose.
- Accidentally giving a child a more concentrated formulation and dosing it wrong (i.e concentrated infant Tylenol (80 mg/0.8 mL) vs. children’s Tylenol (160 mg/5mL)).
- Using kitchen silverware spoons to dose liquid medications instead of a calibrated dosing cup or oral syringe.
- Confusing a tablespoon and a teaspoon.
- Not turning on the lights or being overly tired when getting up in the middle of the night to administer medication to a sick child and accidentally giving the wrong dose or medication.
In summary, there is little evidence that cough and cold medications are effective in children and children are being harmed by the misuse of these medications, leading the FDA to recommend that they not be used at all in small children.
So, what are my options if I have a sick child?
First of all, like my friend assumed, it is not “illegal” to give your children OTC cough and cold medication. In many cases it is still appropriate.
- Always ask your doctor or pharmacist which medication to give and at what dose.
- Make sure you accurately describe the symptoms and provide the age and weight of the child. Remember, children are not “little adults.” It is not appropriate to reduce the dose proportional to an adult or adolescent dose.
- Always use a calibrated dosing cup or syringe when administering medication, not a spoon from your silverware collection.
- Be aware that a tablespoon (Tbsp.) is 3 times larger than a teaspoon (tsp.) and make sure you understand how to identify both on a measuring device.
It is still appropriate to give infants and small children Tylenol (acetaminophen) or Motrin (ibuprofen) to reduce fever and relieve the aches and pains that come with being sick. There are also several non-pharmacological alternatives to medication:
- Saline nasal sprays help relieve nasal congestion and dryness.
- Humidifiers and vaporizers help ease coughing and congestion by moisturizing the air.
- Mentholatum rubs (Vicks VapoRub, etc) help cough and congestion by improving airflow (although not always appropriate in children under 2 years old, especially if the product contains camphor).
It is also important to make sure the child stays well hydrated! Liquids help loosen up congestion.
Finally, take the child to the doctor if the fever is greater than 103°F for one day or 100°F for 3 days, if the cough lasts longer than one week, if there is yellow discharge from the eyes, thick, green discharge from the nose for more than 2 weeks, or the child is dehydrated.
Hopefully all your concerns and questions about this topic have been cleared up. Winter is coming and that means more sickness, so this is great information. Thanks, Lindsay!