When children are sick with yet another upper respiratory infection, we want to make them feel better quickly. We seek to stop the sniffles and cough so everyone can get some sleep.
Groceries and drug stores have seemingly acres of over-the-counter (OTC) products promising prompt relief from the unpleasant consequences of the most recently acquired “bug.” OTC cough and cold products are a multi-million dollar business because they are commonly used in young children to provide relief of symptoms from ear infections, the common cold and sinus infections.
But do they help? And are they safe?
Data from controlled clinical trials of cough/cold product ingredients do not support their efficacy in young children. Several randomized controlled trials of cough and cold medication for children younger than 12 showed no advantages over a placebo. Yet they were responsible for 750,000 calls to poison control centers in a 10-year period.
In 1997, the American Academy of Pediatrics Committee on Drugs concluded that there were no well-controlled studies supporting the anti-tussive (anti-cough) effects of dextromethorphan (the DM in Robitussin-DM medication) or codeine in children.
A recent study concluded that a single dose of buckwheat honey at bedtime performed better than dextromethorphan and codeine. No convincing data proves that antihistamine/decongestant use improves fluid in middle ears.
OTC cough and cold medications have significant potential for harm because of the administration of doses that are too high, the incorrect use of dose measurement devices (for example, the teaspoon) and simultaneous use of several products with similar active ingredients.
Safety data from the Food and Drug Administration during a 37-year period on adverse effects from these products in children younger than 6 include 54 deaths potentially from decongestants and 60 deaths potentially from antihistamines.
In 2008, the FDA issued a public health advisory recommending that OTC cough and cold products not be used in children younger than 2 unless recommended by a health care provider.
Caregivers seeking an effective, safe treatment for the symptoms of upper respiratory infection need to look no further than the kitchen. Nasal saline (salt water) products are available as solutions, sprays and irrigations such as Neti pots or other rinse devices and have been shown to be beneficial in numerous studies.
In older children, warm liquids (such as chicken soup) and honey have been shown to improve the cough associated with a cold. Warm liquids relieve nasal congestion and help prevent dehydration. Honey mixed in warm water can reduce a cough by coating and soothing an irritated throat. Avoid giving honey to children younger than 1.
Nasal washing or nasal irrigation has become more popular recently, though nasal rinsing with Neti pots has been around for centuries. This therapy uses a salt-and-water solution to rinse out the nasal cavity. It decreases the inflammation of the nose by thinning out the mucus lining of the nasal passages.
Studies have shown that people with severe sinus symptoms found relief from doing nasal saline irrigation daily. Once symptoms were relieved, most people continue to rinse two or three times a week, especially during the cold and flu season and allergy season.
After just two rinses, patients feel relief of symptoms. Most patients who suffer from upper respiratory symptoms such as congestion, sinus pressure, sneezing and hoarseness find significant relief after doing a nasal wash. This includes patients of all ages, even children ages 6 and younger.
Maryann Wall, M.D., of Northwest Colorado Ear, Nose, Throat and Facial Plastic Surgery, PC, is board certified in otolaryngology, head and neck surgery and facial plastic and reconstructive surgery.