Coughs, Colds, Respiratory Tract Infections
Children develop upper respiratory tract infections several times a year.
About 80% of these infections are caused by viruses, which run their course
regardless of what medications are offered. The prescription of antibiotics to
treat cold symptoms is one of the more futile actions of MDs, responding to
patient demand Most cold suffers use over the counter cold and cough
pills and syrups that have little or no benefit Prescription cough
medicines are of limited to no value and can be harmful.
The common cold is the most prevalent form of viral infection caused by viruses
such as rhino and corona viruses. More virulent virus such as influenza and
adenoviruses can begin with cold symptoms and progress to involve the lung in
patterns of inflammation that may involve bronchi (bronchitis), bronchioles (
bronchiolitis) or alveoli (alveolitis, a.k.a. pneumonia)
The symptoms of URI make life miserable for up to 10 days.
Nasal congestion is the main symptom of the common cold. Nasal congestion can be
more distressing than cough or sore throat, since it compromises breathing.
Congestion in infants interferes with feeding, since infants must breathe
through their noses while breast-feeding. Adults can clear their nose by
blowing, but infants are unable to clear the nasal airway on their own.
Kogan et al surveyed parents, for example, that 53.7% of parents of
three-year-old children had used over the counter (OTC) medications for their
child in the month prior to the survey. Seventy percent of recent episodes of
URI had been treated with OTC remedies, often containing acetaminophen, a drug
that has no value and that may be harmful.
The American College of Chest Physicians concluded that
cough medicines do little good and may harm children. Paul et al tested two
popular drugs, often included in cough medicines: dextromethorphan (DM) and
diphenhydramine (DPH). The authors concluded that "Diphenhydramine and
dextromethorphan are not superior to placebo in providing nocturnal symptom
relief for children with cough and sleep difficulty as a result of an upper
respiratory infection… the medications given to children do not result in
improved quality of sleep for their parents when compared with placebo.” The
authors also warned that both dextromethorphan and diphenhydramine have
potential for toxicity. For dextromethorphan, adverse effects may include
dystonia, anaphylaxis, bullous mastocytosis, dependence, psychosis, mania,
hallucinations, ataxia, somnolence, type 1 diabetes mellitus, and death from
high doses, particularly when combined with other over-the-counter (OTC)
medications. Dextromethorphan is also a drug of abuse among adolescents. Adverse
effects of diphenhydramine include somnolence, restlessness, nervousness,
insomnia, dystonia, prolonged QT interval, seizures, and death.
In The USA and Canada, 800 cough and cold products are sold to treat
children's viral illnesses, containing about 40 drugs, costing $500 million USD
every year. Sept 2007: Harris reported that safety experts for the US Food and
Drug Administration urged the agency on Friday to consider an outright ban on
over-the-counter, cough and cold medicines for children under 6… the agency may
take strong action against the roughly 800 popular medicines marketed in the
United States under names like Toddler’s Dimetapp, Triaminic Infant and Little
Colds. The reviewers wrote that there is little evidence that these medicines
are effective in young children, and there are increasing fears that they may be
dangerous. From 1969 to 2006, at least 54 children died after taking
decongestants, and 69 died after taking antihistamines, the report said. And it
added that since adverse drug reactions are reported voluntarily and fitfully,
the numbers were likely to significantly understate the medicines’ true toll."
Regardless of what the US FDA decides, parents should
abandon the belief that cold and cough medicines are effective and should be
aware that they can be harmful, especially if the drug effects are combined by
used more than one OTC product or combined with caffeine beverages and stimulant
prescription drugs. See
Children and Prescription Drugs
and Avoid Stimulant
The best strategy for children with colds and cough is to
offer a pleasant cough syrup that is composed of sugar and flavoring without any
harmful drug content. For older children and adults a topical nose decongestant
used only for a few days may be helpful. Topical nasal decongestants can be a
special problem for children under 3 years of age and are best avoided
A nasal aspirator can relieve nasal congestion in infants
and young children. The aspirator is a flexible bulb with a removable plastic
tip. The tip is inserted into the nostril to be cleaned, and gently released. A
gentle suction is applied each nostril sucking mucus into the clear plastic tip.
If secretions are too thick to be removed by this method, a non-medicated, 0.65%
sodium chloride solution can be dropped or sprayed into the nostril. (Baby Ayr,
Ayr Saline Nasal Mist, Breathe Right Saline Nasal Spray). The salt water
solution will liquefy secretions that can then be removed with gentle
Topical nasal decongestants, include nasal drops and
sprays. The main agents are levmetamfetamine, naphazoline, and propylhexedrine.
Pseudoephedrine and phenylephrine should not be given to children below the age
of 6 years. They produce central nervous stimulation that interferes with a
child's sleep and may raise blood pressure.
Ref: The Diagnosis and Management of Cough: ACCP Evidence-Based Clinical
Practice Guidelines available online; accessed 01/2006:
http://www.chestnet.org/ Pediatrics. 2004;114:e85-e90 Harris G. Ban Cold
Medicine for Very Young. NYT September 29, 2007