You won't find formerly popular cold remedies made for infants and young children on the shelves of your neighborhood pharmacy. The Food and Drug Administration recommended the products be removed if they were designed for children 2 and younger last October. Some manufacturers had already voluntarily pulled them.
The over-the-counter remedies don't offer the littlest cold sufferers anything in the way of relief, according to research. No benefit was shown in children up to 6 years old. And they pose a real risk of complications and overdose. The exception to the don't-use rule is when a health-care provider gives specific instructions and a reason to use the product.
"The bottom line is, there is little you can do to improve symptoms related to a cold," says Dr. Jeff Schunk, chief of pediatric emergency medicine at Primary Children's Medical Center.
"If the OTC drugs were particularly effective, they would have caught on and would have a place, with the safety issues. But it's difficult to treat colds and coughs. The medications are not particularly effective for little people. Many adults at least feel some relief. With children, it has been impossible to demonstrate improvement over a placebo. So you're left with treating symptoms."
Whether the remedies work for older kids — those 2-11— is still in question. And there have been cases reported of serious side effects from cough and cold medicines in that age group, including overdoses.
"The American Academy of Pediatrics is working hard to dissuade physicians from recommending and parents from using OTC cold medicines in children less than 6. It's based partly on safety and partly on lack of effectiveness," Schunk says. "That gets to the heart of the problem. When you're doing something that doesn't give benefits, it leads to overdosing. We all want to do something to make children feel better. If any of those things worked really well, there wouldn't be 20 or 30 to choose from at the grocery store. You can't fault physicians and families from wanting to help. But the complications end up in emergency care."
The American Academy of Pediatrics says that more than 7,000 pediatric emergency department visits across the country were made by children 11 and younger who used a cough or cold medication.
The FDA is considering a similar don't-use recommendation up to age 6. They promise a decision this spring.
But the questions remain: What do you do when your baby is having trouble breathing or is fussing with a fever or cough? And how do you make sure you don't accidentally give your older children something that will cause a complication or overdose?
Symptom relief for older children involves tending to the runny nose "and comforting them through the cough," says Schunk. For the littlest children who can't blow their own noses, parents need to actively attempt to suction out their nose. To help that process, moisturize their nasal secretions by humidifying the room or spraying saline into the nose first.
He offers tips. Most families don't like the suction device they are given when a baby is discharged from the hospital because babies cry when they use it. It's uncomfortable. To make it easier, the parent can close off one nostril while suctioning the other, then reversing the process. Blocking one side and blowing the other also improves nose clearing for those who can do it themselves.
As the baby gets older, and bigger, you can cut off a bit of the tip of the suction bulb so it's bigger. "That makes a better seal in the nostril without cramming it up so far," Schunk said.
Medicines can effectively deal with fever, including ibuprofen (Motrin) or acetaminophen (Tylenol). Note that ibuprofen is NOT recommended for children younger than 4-6 months of age. Schunk says parents should never give anything to a baby younger than 3 months without discussing it with a physician. And a fever in a child younger than 2 months should send parents after medical care immediately.
Some providers recommend alternating ibuprofen ad acetaminophen. "There's no proof that works better than either one alone. It's not based on any science. Use one at a time."
In head-to-head trials on reducing fever, Schunk says, ibuprofen performs a little better across the ages in children.
But parents shouldn't be alarmed if they don't get the temperature down. "It's more important to assess the overall well-being of the child than the temperature. And in the smaller children, fever by itself is usually a sign that a child has an infection. "The fever isn't the problem. It's what's causing the fever."
Both ibuprofen and acetaminophen generally work well for sore throats and aches and pains, he says.
It's also crucial to avoid dehydration. Make sure Bobby or Becky get lots of fluids.
The FDA recommends that parents check the active ingredients of an over-the-counter remedy and learn what each ingredient is intended to treat. Multi-symptom remedies, such as cough and cold medicines, usually have more than one. That means parents who give more than one to a child (or take one themselves, for that matter) need to make sure they're not inadvertently doubling up on an ingredient or type. No two with antihistamines, for example.
Always follow dosing instructions, including not only how much but how often. And be precise in measuring, using only measuring spoons that come with the drug or those made specifically for medication. FDA further counsels parents to choose, whenever possible, remedies that have child-proof packaging. Store them where small people can't help themselves. Many of those ER visits were for unsupervised ingestion of the remedies.
OTC drugs only target symptoms, not the illness itself. They don't shorten the length of time a child is sick or provide a cure, the FDA says.
Never, ever, ever use a cold remedy to make a child sleepy. Don't give products made for adults, either. And if you don't understand the instructions, don't use the product. Call someone with expertise.
If you're worried about illness, seek medical care. And remember that the general appearance of the child is more important than the height of the fever," Schunk says.
He says a child who is breathing fast or is using extra muscles to breathe, or a child who is inactive and doesn't interact should be seen by an expert "sooner rather than later."
The academy has created a guide for treating children without OTC medicines. It's online at www.aap.org/publiced/BR_infections.
E-mail: lois@desnews.com