Children's Cold Medicine

More news to share….this time about children’s cold medicine. What’s on the market never works 100% but at least it helps a little so that we can all get a little sleep. To prove my point, here is an article from The Wall Street Journal written by a doctor with kids.

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It's Hard to Heed the Experts When Your Kid Has the Cold

By BENJAMIN BREWER
October 23, 2007; Page B10 (The Wall Street Journal)

The runny nose started in the morning. By bedtime, a cold had settled in my 3-year-old son's chest, and a deep, hacking cough could be heard throughout the house.

At 1 a.m., my wife gave me the look that said: "You're a doctor; do something."

That day, she had heard that an expert panel recommended to the Food and Drug Administration that cold medicines be banned for kids because they work no better than sugar pills and shouldn't be used in children younger than 6. Facing a sleepless night, though, we debated our options. Should we medicate him so we could get some shut-eye, or should we ride it out? We opted for the safe-but-noisy course.

Next thing you know, he's in the bed between us, coughing every two minutes with what seemed like all the muscles in his body. At 3 a.m., the racket woke the dog. My wife took the boy downstairs to rock him in the recliner.

By dawn, Dr. Mom had reached her limit. A dose of combination cough-and-cold medication was soon down the hatch.

After the recommendations against over-the-counter cold medicines came out, we heeded them for less than 24 hours in our house. Once my sick son took the medicine, his sniffles and coughing abated a bit. His symptoms returned later that day, after we discontinued the treatment. Our experience showed that whatever mild benefits these medications offer, they don't last long.

The risks with cough-and-cold medication are clear. If you don't know your phenylephrine from your acetaminophen, you can deliver more potency than you had intended by unknowingly combining products with similar ingredients and confusing chemical names.

Overdoses of medication occur all too often; the FDA has linked over-the-counter medicines to 123 pediatric deaths since 1969. Most of the fatalities were in children younger than 2.

Although experts say cold-and-cough medications don't work in kids, the estimated $2 billion in sales of these products each year suggests to me that at least a few people are finding some value in them. But it may be for reasons you wouldn't think of right away.

Parents often believe they are targeting cold symptoms with these medications, when what they are really doing is sedating the child. Sedation and the potential to depress breathing represent dangerous sides of these medicines.

We all want safe and effective treatments for our kids, but we're finding out that our old way of doing things isn't as safe or effective as we thought it was. Back in 2000, we had to give up the old formula Dimetapp Elixir we used with our older kids because the phenylpropanolamine in it was linked to strokes in young women. The reformulated product never seemed to dry up their noses as well as the original did.

Pseudoephedrine (Sudafed is a brand name) has been linked to strokes, too, but it is still on the market as a decongestant. This medication is being replaced in products by phenylephrine, which doesn't dry a runny nose up as well as pseudoephedrine does.

About 800 cold-and-cough products are on the market, and nearly all are combinations of the same handful of ingredients. The main difference is the marketing.

Nothing available is completely safe or particularly effective for kids. Mothers I have talked to were surprised to learn that their kids' cold medications hadn't been tested extensively. Because the old medications are familiar, we sometimes assume they are safer and more effective than they really are.

Another problem is that the alternatives aren't all that great. If you have ever tried to clear an infant's nose with a suction bulb, you know what I mean. The safety and effectiveness of nasal suctioning hasn't been studied any more than the cold medication. Someone's kid is going to choke on too much nasal saline or have an allergic reaction to the latex in the bulb syringe.

Using a cool-mist vaporizer never seemed to help any of my kids, although I see that recommended frequently. Some parents are fans of Vicks VapoRub and similar substances applied to the skin or put in a vaporizer. In my practice, I have seen such products trigger asthma attacks. That is on par with or greater than the risk from over-the-counter cough suppressants, as far as I am concerned.

The crackdown on cold medicines for kids may have an unintended benefit for me. With infant cold medications off the market, I won't miss the parents calling in the middle of the night for recommendations on how much to use. I won't miss meticulously documenting how many tenths of a milliliter I advised a person to give or the liability risks associated with my advice.

My new answer is simple: "It's just a virus, and, unfortunately, there is no safe and effective cold medication on the market that I can recommend to you."

At my house, though, I have found that the advice to hold off on a kid's cold medicine is much easier to give than it is to heed.