The Over-the-Counter Cold Medicine Dilemma

What to Do – And Not Do – About Your Child’s Cold

Three years ago, government health experts were so worried about side effects from children’s over-the-counter cold medications that they recommended a ban by the U.S. Food and Drug Administration (FDA). Manufacturers pulled the medicines from store shelves – but only those for kids under age 2.

This past May, whole aisles in drugstores emptied out following a recall of 43 over-the-counter children’s medicines by pharmaceutical giant McNeil Consumer Healthcare, makers of Tylenol, Motrin, Zyrtec and Benadryl, due to quality-control problems at their manufacturing plant. And in September, the FDA considered limiting access to cough and cold medicines containing dextromethorphan (DM) because some teens and tweens have been using them to get high.

With cold and flu season under way, what’s a parent to do if a child gets sick?

You Give Me Fever

Fever?Watching your child’s temperature climb can be unnerving, but so can learning that the medications you’ve trusted to fight fever – like children’s Tylenol or Motrin – have been pulled from stores because of safety concerns.

“I was very upset when I called about the recall,” says mom Jill Koala-Ines, adding that her family had to dispose of children’s formulas of both Tylenol and Advil. “They were so nice to refund my money and I appreciated the time and concern they took to make sure I disposed of the product properly, but I was disheartened to learn that the product would not be available.”

Fortunately, fever in and of itself isn’t generally a danger to your child’s health. Bringing a fever down just makes a child feel better. “It’s not the [temperature] number that we care about, it’s whether the child is comfortable or not,” says Carlos Lerner, M.D., medical director of the UCLA Children’s Health Center.

Plus, the manufacturer pulled Tylenol and Motrin from the shelves because of a problem at the manufacturing plant, not an ongoing problem with the medications themselves. “These are very safe medications if given in the appropriate doses, and are well known to work,” says Lerner. (He also reminds parents never to give aspirin to children because of its links to more serious illness in kids.)

Time for Chicken Soup

Still, if you’d rather not risk an over-the-counter (OTC) product, one strategy is to nurse kids the way our grandmothers did. Lerner, whose daughters are ages 6 and 3 1/2, takes this approach. “We generally don’t recommend [OTC cold medicines] for children under 6 years of age, and even in older children it’s not clear that they work,” he explains, adding that the side-effect risks in this age group outweigh the paltry benefits.

Those side effects can range from simple sleepiness with decongestants and cough medicines, to nausea, elevated blood pressure and heart palpitations. Even with trusted medications like Tylenol, children have suffered severe liver damage, or even died, from overdose.

With more parents concerned about OTC side effects and whether children’s cold medicines are even effective, an old-school approach to colds is coming back into vogue:

• Hot tea with honey for cough;

• Popsicles for sore throat;

• Plenty of fluids;

• A humidifier or steamy shower to reduce congestion; and

• Saline spray to help clear stuffed noses.

A Word About Cough

Even among cautious parents, a hacking cough that keeps your child up at night can make it tempting to reach for any sort of relief. Michigan pediatrician Matt Davis, M.D., director of the C.S. Mott Children’s Hospital National Poll on Children’s Health and the father of a third-grader and an eighth-grader, has been there.

“The fact of the matter was, at 2:30 in the morning our kids were congested,” he says, “so I reached out and tried these things, and found out that sometimes they worked and sometimes they really didn’t.”

Recent clinical trials have found this to be especially true of DM, the main ingredient in most over-the-counter cough medicines. Another problem with DM: it’s a narcotic that acts on the central nervous system; it’s dangerous in large doses and ripe for abuse.

Pediatrician Zak Zarbock, M.D., was invited to September’s FDA meeting on abuse of DM products. There, he recommended age restrictions for purchasing the products and labeling to indicate that they’re not recommended for children under age 6.

Zarbock, a father of four, also invented an alternative. Taking his lead from a 2007 Penn State study that found that buckwheat honey relieved cough symptoms in children better than DM, Zarbock created Zarbee’s, a natural honey-based cough syrup. According to Zarbock, honey coats the throat and relieves irritation, and its sweetness causes the brain to release calming chemicals called endorphins, which help reduce the urge to cough.

The Right OTC Choice

If your kids are older than age 6 and you’re going to reach for an OTC remedy, here are a few guidelines from the experts:
• Stick with single-ingredient medications. Purchase separate medications for fever, cough and congestion, rather than a combination product designed to work on multiple symptoms. Parents often overdose their children when giving these combo medications, because they aren’t aware of all the active ingredients.

• Generics work fine – if your child will take them. While the active ingredients will be the same, generics often have a different taste, texture or color than the brand names. “Know the flavors that your kid likes,” advises Davis of CS Mott Children’s Hospital.

• Ask your doctor about the proper dose. “These medicines are all weight-based, not age-based,” Davis says. A pediatrician can give you the correct dose for your child’s weight, which is more accurate than the package recommendation.

• Use the measuring device that was packaged with the medication. This helps ensure that you’re giving the correct dose.

• Follow package directions. Never use adult medications, or medications meant for older children, on your young child.

And an Ounce of …

Obviously, the best way to treat a cold is not to get one in the first place. “The No. 1 way to help cough is prevention,” says Zarbock. So make sure your children are well-rested, eat a healthy diet, exercise regularly and wash their hands often.

If your child does get sick, you now have some strategies at the ready. But if these don’t seem to be working – if your child has trouble breathing, isn’t sleeping, has high fever that won’t come down – or if you just don’t feel that your child is getting better, the best strategy of all is to see your doctor.

Christina Elston is a senior editor and health writer for Dominion Parenting Media.