The Latest Guidelines on Cold and Cough Medicine for Kids

By Dr. Eric Ball, a CHOC Children’s pediatrician

When your child is sick, all you want to do as a parent is make them feel better. As a pediatrician and parent, I understand that frustration. Today, parents are inundated with countless over-the-counter products marketed as safe for kids. Unfortunately, we now know that these pediatric versions of adult medication may do more harm than good.

The U.S. Food and Drug Administration do not recommend over-the-counter medicines for cough and cold in children under 2 years old. For older children, consult your pediatrician or pharmacist before offering any over-the-counter medication. Do not give medicines containing codeine or hydrocodone to anyone under 18 years old. These are opioids and are not advised for children.

Why can’t I give my child cold and cough medicine?

There have been few studies that have actually looked at the effectiveness of cold and cough medications in alleviating cold symptoms in children. Of the studies performed, every study done since 1985 has shown no benefit to any of these medications compared to a placebo. In other words, each study showed that a sugar pill had the same effects as the cold medications. Cough medications did not stop coughs, decongestants did not make children less congested, and expectorants did not make mucous any more manageable. Even if the medications did work, they would only treat symptoms of a cold; they do not cure or shorten the duration of the illness. Children get better with time.

When the original dosing studies for these over-the-counter cough and cold medications were performed, safe dosages were established only for adults. The FDA licensed the medications for children in 1976 without any studies establishing safe doses for children. Pediatric dosing was extrapolated from adult dosing using a crude formula: half of the adult dose for children between 6 and 11 years of age and a quarter of the adult dose for children between 2 and 5 years of age. For children under 2 years of age, parents were instructed to ‘contact your doctor.’ These extrapolated doses are imprecise and potentially dangerous; it puts children at much higher risk for adverse effects and accidental overdose.

So, what can I do about a cough or cold?

There is no cure for the common cold, but there are some things you can do while the virus runs its course.

  • Make sure your child drinks plenty of fluids. This will serve to thin mucous and keep him well hydrated.
  • Saline drops or sprays can offer temporary relief of a stuffy nose.
  • A bulb syringe can be used for children too young to blow their noses.
  • A humidifier is often helpful for decreasing congestion at night.
  • Acetaminophen or ibuprofen (for children over six months old) are safe and effective in relieving pain or fever associated with a cold. CHOC offers downloadable guides on acetaminophen (Tylenol) dosing, as well as a guide on ibuprofen (Advil) and naproxen (Aleve).

Not every cough and cold warrants a trip to the pediatrician’s office. Here are a few warning signs that it’s time to make an appointment:

When to call the doctor for a cough or cold:

  • A fever in a baby less than 2 months old
  • A fever of 100.4 degrees or higher lasting more than three days.
  • Labored breathing including wheezing, fast breathing or shortness of breath
  • Dehydration along with not eating or drinking
  • Constant ear pain

The dangers of over-the-counter medicine for children

Since 2000, poison control centers have reported hundreds of thousands of calls related to over-the-counter cold medications in children. The FDA has reported 123 deaths related to decongestants and antihistamines since 1969. Since appropriate dosing has not been established, side effects tend to be more severe in children. Cough suppressants, which are derived from narcotic-type medications, often cause drowsiness, confusion, and other neurologic effects. Decongestants are related to amphetamine-type medications and cause agitation, insomnia, restlessness, and high blood pressure. Antihistamines, which are often marketed as bedtime medication, cause drowsiness in some children and agitation in others. Expectorants can cause gastrointestinal effects, such as nausea, vomiting, and diarrhea.

Find a CHOC pediatrician near you

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What Every Parent Should Know About Emergency Departments During Flu Season

This year, thousands of people are packing their local emergency department during flu season. As the region’s only pediatric-dedicated facility, the Julia and George Argyros Emergency Department at CHOC Children’s Hospital is seeing an extremely high number of patients, from infants to teens. Our physicians and staff understand how anxious and scared parents and children can get when faced with a trip to the emergency department. They offer the following information and tips for parents coming to the emergency department during the busy flu season:

  • Be prepared to see a full lobby, including people seated in chairs down hallways and in additional areas throughout the department. Typically, the department gets busier as the day progresses. CHOC has added staff to help manage wait times.
  • Leave siblings and other family members at home, if possible. This will help ease crowding, but more importantly, keeps well children from being exposed to sick ones. Also, parents’ attention should be focused on their ill or injured children.
  • Patients are seen based on how sick or injured they are, not on the order they arrived in the emergency department. Please keep in mind there are patients who arrive in ambulances – admitted in an area beyond your view. Our staff must treat the sickest first. If you’ve been waiting and are concerned your child’s condition is getting worse, please ask a nurse to reassess her.
  • Hold off on giving food or drink to your child until she’s been seen by the doctor. A full stomach can delay procedures and the use of sedatives.
  • There are nurses and emergency medical technicians (EMT) who work in the lobby and have different roles. Nurses, dressed in maroon scrubs, help screen and assess patients; some will assist with lab work or X-rays. EMTs, dressed in tan scrubs, can only take vitals and measure height and weight. EMTs will notify the nurses in the lobby of any changes they observe in patients’ conditions.
  • Don’t expect a prescription for antibiotics, which aren’t always the answer. Antibiotics can only treat infections caused by bacteria. Cold illness caused by viruses can’t be cured with an antibiotic.
  • Try to stay calm. Children can pick up on their parents’ fear and anxiety. Take deep breaths for your and your child’s sake.
Download a checklist of what to bring to the emergency department

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5 Questions to Ask When Your Child Has a Fever

The thermometer says your toddler has a 101-degree fever, but he’s acting like his usual self. Is a doctor’s appointment necessary? Answering these five questions can help caregivers decide if it’s time for a visit to the pediatrician.

dr-jonathan-auth-choc-childrens-pediatrician
Dr. Jonathan Auth, a CHOC Children’s pediatrician, encourages parents to ask these five questions when your child has a fever.

How old is the child?

Babies aged 3 months and younger with temperatures 100.4 degrees or higher should be evaluated by a physician immediately, says Dr. Jonathan Auth, a CHOC Children’s pediatrician.

How long has he had the fever?

If the child has a fever and typical cold symptoms, but is otherwise acting well, a fever can last for three to five days before parents ought to seek medical attention, Dr. Auth says.

“After more than five days, you should see a doctor because it increases the risk of other complications,” he says.

How high is the temperature?

A temperature hovering at 102 in a child might be alarming, but Dr. Auth says it’s common for children younger than 5 to spike high temperatures when ill.

In these cases, caregivers ought to work to make the child more comfortable by employing a fever reducer like acetaminophen, which is gentle on the stomach and safe for children of all ages.

When temperatures creep to 104 degrees, a parent should make an appointment with a pediatrician, Dr. Auth says. If a child has a 105-degree fever that doesn’t decrease abruptly with acetaminophen, go to urgent care, he says.

Where in the course of a child’s illness did the fever surface?

Generally, if a fever accompanies a cold, it will arise at the beginning of the illness, Dr. Auth says.

A fever that appears more than three days after cold symptoms first surfaced, however, could be an indicator of a secondary infection such as pneumonia, ear infection or sinus infection, he says.

In these cases, call the pediatrician.

Does the child also have body aches?

A high fever early in an illness that is accompanied by body aches or headaches can be an indicator of influenza, Dr. Auth says.

Parents who suspect their child has the influenza should seek medical attention early in the course of the illness. Specific anti-influenza medications can be used to shorten the duration of illness as well as reduce the risk of potential complications and minimize contagiousness.

A flu shot is the best way to protect children against the flu, and is recommended for all children older than 6 months.

Learn more about CHOC’s primary care services.

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Should My Kids Get the Flu Shot This Year?

Many parents have expressed concern over the last few months that this year’s influenza vaccine may be less effective than in years past and wondering, “Should my kids get the flu shot this year?” These concerns stem from data released after Australia’s flu season, where recent reports indicated low effectiveness of the vaccine.

“We’re using the same vaccine here in the United States, so people think it won’t be effective,” says Dr. Jasjit Singh, a pediatric infectious disease specialist and medical director of infection prevention and control at CHOC Children’s.

dr-jasjit-singh-choc-childrens
Dr. Jasjit Singh, a pediatric infectious disease specialist and medical director of infection prevention and control at CHOC Children’s., addresses parents’ annual concerns over, “Should my kids get the flu shot this year?”

These doubts are misguided, says Singh. Although reports show Australia’s vaccine was only 10 percent effective, that data was specifically looking at the H3N2 strain that had dominated the southern hemisphere this year, she says. Effectiveness against the same strain in the US has been as high as 30-40 percent, and even higher against other strains of influenza in the past.

“We can’t take that one statistic and apply it to all strains of the flu in the US this season,” Singh says.

It’s important for parents to remember that the although the vaccine helps prevent children and adults from getting the flu, physicians are especially concerned with preventing influenza-related hospitalizations or even death.

“People forget that children and adults can die from influenza. So far in the U.S. there have been nine pediatric flu-related deaths this season,” Singh says.

Since the 2004-2005 flu season, flu-related deaths in children have ranged from 37 to 171 each season, according to the Centers for Disease Control.

A recent study published by the American Academy of Pediatrics examined vaccine effectiveness in 291 pediatric influenza-associated pediatric deaths from 2010-2014. Vaccine effectiveness was 51 percent in children with high-risk conditions, compared to 65 percent in children without high-risk conditions.

“This shows that many of our deaths are in otherwise healthy children,” Singh says.

Although it’s best to get vaccinated early in the season, it’s better to be vaccinated later in the winter than not at all.

“Very often, people get vaccinated because someone they know has the flu. It takes two weeks for the vaccine to take effect, so if your child has been exposed to the flu in that time period, they can still get sick,” she says.

Parents should remember that children cannot get from the flu from getting a flu shot.

“The vaccine is not a live vaccine, so it’s impossible to get the flu from getting a flu shot,” Singh says. “the vaccine prevents influenza virus, but during winter months there are many other viruses that cause colds and respiratory viruses, that are usually milder than the flu.”

Those who decline a flu shot because they “never get the flu” still need to be vaccinated, she adds.

“It’s important to remember that some people may have minimal symptoms, but can still pass the virus to others who may be vulnerable to more severe disease.”

The single best way to protect your child from the flu is by getting them vaccinated each year. In addition to receiving an annual influenza vaccine, there are other things parents and caregivers can do to help prevent the flu. Use proper hand-washing techniques, use respiratory etiquette, and stay home from work or school if you are sick with the flu, to prevent spreading it to others.

Download your immunization guide

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What Parents Need to Know About Hand, Foot and Mouth Disease

Hand, foot, and mouth disease (HFM) is a viral illness that usually affects infants and children younger than 10 years old, specifically those 1 to 5. We spoke to Dr. Jonathan Auth, a CHOC Children’s pediatrician on what to expect with this common condition.

hand foot and mouth disease
Dr. Jonathan Auth, a CHOC Children’s pediatrician, explains hand, foot and mouth disease

Q: Is HFM contagious?

A: Yes, it can be spread through contact with feces, saliva, or mucus. The virus is common year round but tends to cluster in the summer and fall.

Q: What are the symptoms?

A: A fever is usually the first sign of the virus, followed by a reduced appetite and sore throat, which can cause a child to feel achy and irritable. After a few days, painful sores (red-yellowish blisters) develop in the back of the roof of the mouth. A skin rash with red spots may appear in the palms of the hands and soles of the feet, as well as on the knees, elbows and buttocks area.

Q: What should a child with HFM eat?

A: Make sure your child drinks plenty of fluids, such as water or milk, to stay hydrated. How much water should your child drink? At CHOC Children’s, we recommend that children drink the amount of 8 ounce cups of water equal to their age, with a maximum of 64 ounces for children over the age of 8. Most children do not have much of an appetite during this time. Cold or soft foods, such as popsicles, ice cream, yogurt or jello, are the most soothing given the sores on the throat.

Q: How is HFM treated?  

A: HFM usually clears up within a week. While there is no medical cure or vaccination for HFM, your child’s pediatrician can recommend ways to make your child more comfortable while the illness runs its course. Acetaminophen or ibuprofen can be given to ease painful mouth sores or discomfort from the fever. Download a parent’s guide to acetaminophen for children.

Children with blisters on their hands, feet or rest of the body should keep the areas clean and uncovered. Wash the skin with lukewarm soap and water, and gently pat dry.

Everyone in the family should wash their hands often, especially after using the toilet or changing a diaper, and before preparing food. Shared toys should be cleaned often, as viruses can live on objects for a few days.

Call your child’s pediatrician if your child is sluggish, can’t be comforted or seems to be getting worse.

Q: Are there any complications?

A: Complications are rare. Occasionally, some complications could arise, such as dehydration, due to a child not eating well, or not being able to swallow enough liquids because of painful mouth sores. Sometimes the rash or sores on the body can be infected if there are breaks in the skin.

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