Cold medicines for kids: What's the risk?

Over-the-counter cough and cold medicines are the best way to help a child who has a cold feel better — right? Think again. Here's practical advice from Jay L. Hoecker, M.D., an emeritus pediatrics specialist at Mayo Clinic, Rochester, Minnesota.

What's the concern about cough and cold medicines for kids?

Over-the-counter cough and cold medicines are intended to treat the symptoms of coughs and colds, not the underlying disease. Research suggests that these medicines haven't been proved to work any better than inactive medicine (placebo). More important, these medications have potentially serious side effects, including fatal overdoses in children younger than 2 years old.

Don't use over-the-counter medicines, except for fever reducers and pain relievers, to treat coughs and colds in children younger than 6 years old. Also, consider avoiding use of these medicines for children younger than 12 years old.

What about antibiotics?

Antibiotics can be used to combat bacterial infections but have no effect on viruses, which cause colds. If your child has a cold, antibiotics won't help. Remember, the more your child uses antibiotics, the more likely he or she is to get sick with an antibiotic-resistant infection in the future.

Can any medications help treat the common cold?

An over-the-counter pain reliever — such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Children's Motrin, others) — can reduce a fever and ease the pain of a sore throat. However, fevers are generally harmless. The main purpose for treating them is to help your child feel comfortable.

If you give your child a pain reliever, follow the dosing guidelines carefully. For children younger than 3 months old, don't give acetaminophen until your baby has been seen by a doctor. Don't give ibuprofen to a child younger than 6 months old or to children who are vomiting constantly or are dehydrated.

Also, use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children.

Is codeine OK?

No. The Food and Drug Administration limits the use of prescription cough and cold medicines containing the opioids codeine or hydrocodone to adults age 18 and older. This is due to the potential for slowed or difficult breathing, misuse, risky use, addiction, overdose and even death.

How can I help my child feel better?

To help your child cope with a cough or cold:

• Offer fluids. Liquids such as water, juice and broth might help thin secretions. Warm liquids, such as tea or chicken soup, might have a soothing effect, increase the flow of nasal mucus and loosen respiratory secretions.
• Run a cool-mist humidifier. This can add moisture to the air, which might decrease the drying of the nasal passages and throat. Place the humidifier near your child's bed. Clean the humidifier after every use.
• Use nasal saline. Over-the-counter saline can keep nasal passages moist and loosen mucus. In younger children, apply saline nasal drops, wait for a short period and then use a suction bulb to draw mucus out of each nostril. For older children, use a saline nasal spray or saline nasal irrigation.
• Offer cold or frozen drinks or foods. Ice cream, frozen fruit pops, ice or cold beverages might feel good on a sore throat.
• Encourage gargling with salt water. For children age 6 years and older, gargling with warm salt water might soothe throat pain.
• Offer hard candy. For children age 5 years and older, sucking on a piece of hard candy might soothe throat pain. Hard candy is probably as effective as medicated lozenges and less likely to have harmful effects. However, hard candy is a choking hazard and shouldn't be given to younger children.

What's the best way to prevent the common cold?

To help your child stay healthy:

• Keep it clean. Teach your child to wash his or her hands thoroughly and often. When soap and water aren't available, provide an alcohol-based hand sanitizer. Keep toys and common household surfaces clean, too.
• Steer clear of colds. When possible, help or encourage your child to avoid close contact with anyone who has a cold.
• Avoid touching his or her face. Your child can get sick by touching something contaminated with germs and then touching his or her eyes, mouth or nose.