When a young child comes down with a cold — congestion, a scratchy sore throat and runny nose, maybe with greenish goo — many parents head straight for the drugstore for a bottle of children's cold medicine.
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 do not work for children younger than 6, and they provide only a negligible benefit for children 6 to 12.
I notice two reactions when I share this information with parents in my pediatric practice: surprise, because these medications appear to work, though that's really just because cold symptoms naturally wax and wane throughout the day; and frustration that there isn't a medicine to just make the cold go away.
A common cold is the most frequent infection people get; more than 200 viruses cause these infections. Older children and adults tend to come down with a cold two to four times a year; young children get them six to 10 times a year. This is normal and not a sign that something is wrong with a child's immune system. Because colds are more common during the school year, some children will get a cold every month between fall and spring. So it's no wonder that parents want to reach for a cold medicine.
But 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 "adverse effects" sometimes experienced when using cold medicine, such as heart racing, drowsiness, dizziness and nausea, needed to be weighed against any benefit.
The truth is, a cold has a predictable life span, and not much can be done to interrupt it. When a child starts to get a runny nose, sounds congested and acts cranky because his throat hurts, you know a cold has settled in. The sore throat usually resolves in a couple of days, but it may be replaced by sinus pain, headache, muscle aches, a hoarse voice and cough.
Children are more likely to develop a fever with colds than adults are. 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 10 days but may last two or three weeks. (Contrary to what many people believe, discolored nasal mucus usually does not require antibiotic therapy.)
Given the recent surge in flu cases, it's worth noting that, like a cold, influenza is a viral infection and that over-the-counter cold medications won't work any better against it than they will against other respiratory illnesses. However, there are prescription antiviral agents (Tamiflu, Relenza) that can shorten the course and severity of illness if started promptly.
Even though cold medicines for children don't work, most come with labels describing promising relief for many of the symptoms that accompany the illness: congestion, runny nose, cough, thick mucus, aches and fever. Let's look at the evidence.
One of the prime ingredients in many cold medicines are antihistamines. Histamine is a chemical released by the body if a person is allergic to things such as pollen, dust or animals. Histamine causes blood vessels to swell, which in turn causes congestion, runny nose, itchy eyes and cough from postnasal drip. 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.
One of the side effects of the antihistamines used in cold medicine is sedation. Doctors sometimes recommend these drugs for their sedating properties — that is, to help sick children sleep. There are limited data to show this works. But in fact some children become agitated or develop other side effects on antihistamines, and that's one of the reasons the American Academy of Pediatrics does not recommend using cold medication for its sedating properties.
The newer antihistamines found in many allergy medicines have no effect on the symptoms of a cold.
There are lots of blood vessels in the nasal and sinus passages. Cold viruses create inflammation that causes the blood vessels to swell, thereby narrowing the passages that bring air into your body. Decongestants are designed to reverse this process. They come as oral and spray preparations.
Although there is evidence that decongestants work in teens and adults, the same thing isn't true in young children.