Your child is sick - cough and runny nose, not sleeping at night. Common complaints this time of year. Should you give a cold
medication? What should you make of recent reports that these medications not only do not work in young children but are unsafe?
That is just what I talked to Karen Swensen about on yesterday's HealthWeek on New England Cable News.
The data on over the counter medication use in children teach us two important lessons:
1. They are completely ineffective, especially in infants and toddlers.
2. They can be toxic in small infants and children and even fatal.
In fact, 3 infants died in 2005 after being given over the counter cold products.
Part of the confusion over the safety profile of popular cough and cold medications is misleading advertising. Take Pediacare Infant Decongestant Drops, for example:
The directions on the box and web site:
* children 2 to under 6 years of age: 2 dropperfuls (1.6 mL). If needed, repeat dose every 4-6 hours. Do not exceed 4 doses in 24 hours.
* infants (under 2 years of age): Consult a doctor
Pediacare is in good company when it comes to misleading advertising and directions. For example, Tylenol Infant Drops Plus Cough and Cold.
The directions on the box, and web site read:
Under 24 pounds, Under 2 years of age: consult a doctor
24-25 pounds, 2-3 years of age: 1.6ml (2 0.8ml droppers). If needed repeat every 4 hours.
Next time you are out, stroll down the cold and cough aisle at any convenience store, supermarket or drug store and you'll see this situation applies to every cough and cold product labelled as "infant". This is a huge problem and clearly needs to be addressed. The only company I could find that has changed it's labelling practices in light of safety concerns is Dimetapp whose label now reads "Toddler's Drops Decongestant". Same product and dosing as their older infant product just more realistically and appropriately labelled. In fact, their warning list clearly reads "Do not use in a child under 2 years of age". Note it does not say "consult" but "don't use". This is an important distinction and hopefully more pharmaceutical companies will follow suit.
Just because medications are ineffective in helping your child feel better, there is a great deal you can do at home even with out medication. Simple, old fashioned remedies - rest, drinking well, saline nose spray and bulb syringe and a humidifier. I often hear parents report they want to use something to help their child sleep. I completely understand that concern having spent many nights up with my own kids. Part of the issue with small children is that their sleep is cumulative during the day so extra napping due to illness will short change their sleep at night. And, sleeplessness is often a component of many viral illnesses.
What will make this better and get everyone sleep? patience and time. I know it is frustrating to see your infant sick but the only true use for these medications is the placebo effect for us parents - we want to do something and feel better trying. But, given what we now know, it is just not worth tempting fate. This is one situation where the only true cure is a tincture of time. And, for other situations where that is not working, your pediatrician is a phone call away.
Email Dr. Gwenn
Images 1 and 2
Pediacare Image
Tylenol Infant Image
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