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Do not give decongestants or antihistamines to young children, experts warn

In children, the effects of decongestants and antihistamines can be particularly severe.

Children under the age of 6 should not be given decongestants or medicines containing antihistamines for the common cold, and children under the age of 12 should be given those drugs only with considerable caution, warns an international team of medical experts in an article published online last week in the BMJ.

Not only do over-the-counter (OTC) cough and cold preparations offer little or no relief from a runny or blocked nose, their safety in young children is unclear, the article points out.

Side effects from decongestants and antihistamines in people of all ages include drowsiness, headaches, stomach upset and an increased risk of insomnia. In addition, the long-term use of decongestants can actually make nasal congestion worse — a situation that may become chronic and difficult to reverse.

In children, the effects of decongestants and antihistamines can be particularly severe. Indeed, decongestants have been associated with rapid heart rate, convulsions and, in rare cases, death in very young children.

The authors of the BMJ article, led by Dr. Mieke van Driel, a general practitioner at the University of Queensland in Brisbane, Australia, reached their conclusions about OTC cough and cold preparations after examining the latest Cochrane reviews on the topic. Cochrane is a nonprofit global organization that recruits teams of independent scientific reviewers to sort through all the clinical trials on particular medical treatments and come to a conclusion about what the best studies show about those treatments.

Mistaken parental assumptions

The BMJ warnings regarding OTC cough and cold preparations are not surprising. In 2008, the U.S. Food and Drug Administration (FDA) said such products should not be given to children younger than 4 and only with caution to older children.

The American Academy of Pediatrics also recommends against the use of cough or cold preparations in young children.

Yet many parents continue to give such products to their children, mistakenly assuming that they must be safe because they can be bought without a doctor’s prescription.

They also believe the advertising claims  — which are supported only by low-quality evidence involving adults — that OTC products can alleviate nasal symptoms, such as congestion, runny nose and sneezing.

Other popular treatments

The common cold is caused by viruses and is usually self-limiting, typically lasting no longer than 10 days.

Yet, although rarely serious (unless a secondary infection, like pneumonia, develops), colds can make life miserable for those few days and can also have “a substantial impact on work, school, use of health services, and money spent on medications,” van Diel and her co-authors write.

Adults get an average of two to four colds a year. Children are much more susceptible, however, averaging six to eight colds a year.

No wonder, then, that the average American shops for OTC cough and cold preparations 26 times a year, according to the Consumer Healthcare Products Association.

Many people also try other OTC and home treatments for the common cold, including heated humidified air, eucalyptus oil, Echinacea, garlic, Chinese medicinal herbs, probiotics, vitamin C and zinc. Yet, as van Diel and her colleagues point out, there is no good evidence to support the effectiveness of any of those treatments, either.

Research has, however, found that some “alternative” remedies can cause unwanted side effects. A study linked the use of the herb echinacea, for example, to an increased risk of developing a skin rash.

Van Driel and her colleagues do give a lukewarm OK to one home remedy — not because it is necessarily effective, but because it hasn’t been linked to safety concerns.

“If parents are concerned about their child’s comfort, saline nasal irrigations or drops can be used safely, but this may not give the desired relief,” they write.

(Never use tap water for nasal rinses, however, as such water can cause serious infections when introduced directly into nasal passages. Use only a sterile saline solution, and follow directions carefully.)

What parents can do

What can parents do to help their children feel better as they wait for cold symptoms to pass? Here are some tips from the FDA:

  • A cool mist humidifier helps nasal passages shrink and allows easier breathing. Do not use warm mist humidifiers. They can cause nasal passages to swell and make breathing more difficult.
  • Saline nose drops or spray keep nasal passages moist and helps avoid stuffiness.
  • Nasal suctioning with a bulb syringe — with or without saline nose drops — works very well for infants less than a year old. Older children often resist the use of a bulb syringe.
  • Acetaminophen or ibuprofen can be used to reduce fever, aches and pains. Parents should carefully read and follow the product’s instructions for use on the Drug Facts label.
  • Drinking plenty of liquids will help children stay hydrated.

FMI: You can read the BMJ article in full on the journal’s website.

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