Recently, my girls were down with a bout of cough, mild running nose and a phlegmy throat. When my eldest girl coughed, the phlegm in her throat made her cough sound pretty bad. Someone close to the girls passed a remark as to why I am reluctant to bring them to see the doctor to get medication. This person remarked that if the cough continues, it may cause injury to the lungs.
Truth is I always believe that the flu and cough will resolve on its own, naturally. The body can heal on its own. I do not believe in cough and flu meds and I have never fed them to Cass, my youngest daughter. First, her tiny body had been exposed to too much antibiotics since she was 6 weeks old until she was about 15 months old – taken on a daily basis for the UTI attacks that she got caused by Kidney Reflux. Secondly, her body has also been exposed to too much radiation from scans and various invasive tests. During her surgeries 5 years ago, her petite body was exposed to GA, sedatives, morphine and a host of other medications. I do not want to burden her body any further with synthetic medication.
Cass and my 2 other girls have had been attacked by the flu and strep throat bugs umpteen times and I thank God that I managed to treat them without the use of medication. I have my own way of treating them by using Manuka honey UMF 10+, Propolis, Esberitox along with fruits and juices. Abstinence from certain type of food is very important too. My girls and I have a very ‘heaty’ body, so abstaining from fried food, spicy and oily food and overly sweet food helps to speed up recovery. My method always worked well on my girls and on myself and I thank God for it.
Today I googled on the usage of cough and cold medication for children and what I found from Science-Based Pharmacy is interesting. Here are the excerpts from the website:
In 2008, a Food and Drug Administration (FDA) advisory panel concluded that cough and cold products in children were ineffective and potentially hazardous. The committee recommended that they should be relabelled to indicate “do not use” in children under the age of six. Following this announcement, product manufacturers voluntarily relabelled their products to state “do not use” in children under the age of four.
Around the same time, Health Canada announced that cough and cold products will be relabelled to caution against use in children under the age of six. Products developed just for this age group will be no longer be sold. This extends an earlier decision to remove any products intended for children under the age of two.
In Australia, cough and cold products are now labelled “do not use” for those under the age of 2, and are available only with a prescription. They continue to be marketed and sold with labelling for children aged 2 – 12.
In the United Kingdom, products for children under the age of six are currently being withdrawn. Medication for children aged 6 – 12 will continue to be available, with new warnings on the label.
So depending on where you live, certain products may or may not be sold, and dosing instructions for children may vary dramatically. Given the average household has four to eight over-the-counter cold medications, efficacy and safety questions are highly relevant to most consumers. So how did four different countries arrive at different conclusions? Is any decision the right one? This review will focus on the evidence base supporting cough and cold products for children.
The Nature of Colds in Children
Colds are viral infections, caused by a variety of respiratory viruses. Children get the most colds (6 – 8 per year), and they tend to last longer – up to two weeks each time. Adults contract 2 – 4 colds annually, and then tend to last 7 days on average. Cold symptoms experienced by children differ from adults. Runny noses are the most common sign, and fever is common in the first three days. Other common symptoms include sore throat, cough, difficulty sleeping and reduced appetite. Ear complaints are also common.
Treatments
There is no cure for the common cold, and treatments are intended to reduce symptoms. The most common drugs in non-prescription cough and cold products are antihistamines, decongestants, cough suppressants, and expectorants. Each manufacturer puts together their own concoction, with either single-ingredient or multi-ingredient formulas. The main features that distinguish a product like Benilyn from Triaminic or Dimetapp are packaging, flavouring, and marketing – the ingredients are typically identical within each category.
Fever reducing drugs (i.e,, Tylenol or Tempra (acetaminophen); Advil or Motrin (ibuprofen)) are used to treat fever and pain from colds. Fever reduction is acceptable but not essential when treating a cold. Both acetaminophen and ibuprofen effectively reduce fever and are safe when used as directed. No countries have recommended restricting their use in children.
Examining Efficacy in Children
Cough and cold products have been sold for decades, and were approved for sale long before rigorous proof of efficacy was required. Consequently, clinical studies that support these drugs are (in general) of poor quality.
When we look at studies specifically in children, the data are even more limited. Research results are complicated by different age groups, irregular dosing, lack of placebo control, and very small patient numbers. [2] It turns out that the current recommended dosage for children, typically determined during clinical trials, is based mainly on expert opinion. When these products were originally approved, it was assumed that children were just “small adults” and that research in adults could be applied to children. Dosages were estimated based on ages – not weight, which would be more relevant. [2]
But children are definitely NOT small adults. Differences exist in how children absorb drugs (amount of stomach acid) and where the drug goes in the body (body fat percentage). Their ability to metabolize drugs may differ, due to an immature liver. Consequently, drugs can behave in different and unpredictable ways, compared to adults.
Few studies have examined how cough and cold products behave in children. Consequently, their absorption, distribution, metabolism and elimination are poorly understood. The FDA expert advisory panel indicated that it was inappropriate to extrapolate data from adults to children.[3]
Despite the lack of direct research, cough and cold products have a long history of use in children with very rare reports of toxicity, usually due to inappropriate (excessive) dosing. In general, these drugs have a wide “therapeutic window”, meaning that large overdoses are required before serious side effects are expected.
So let’s consider the evidence to support their use. Literature searches have identified only a handful of clinical trials studying children, with few trials demonstrating efficacy.
Expert Opinion
When there is insufficient data from clinical trials, it is reasonable to consult expert opinion for guidance. The following organizations have made statements:
The Canadian Pediatric Society (CPS) provides advice consistent with Health Canada, recommending against treatment with cough and cold products in children under the age of six. The only acceptable exception are fever-reducing drugs (ibuprofen and acetaminophen).
The American Academy of Pediatrics has concluded that there is sufficient evidence to conclude that cough and cold products are ineffective in children under 6 years old. It has regularly criticized multi-ingredient products as well as the lack of data to support the recommended dosages.
The American College of Chest Physicians has concluded that the published data does not support the efficacy of cough and cold products in the paediatric age group.
Summary of the Evidence
There is little convincing evidence that these products are effective in children up to about age 18.
Serious side effects are rare, and usually associated with high doses, typically the consequence of administration errors.
Parents and caregivers may be unaware of the risks of excessive doses.
Excessive doses may be accidentally caused by the use of multiple products at the same time.
Evidence-based dosing guidelines are problematic due to the lack of good quality evidence.
Summary
Despite a long history of reasonably safe use, we must hold cough and cold products to the same standard that we would apply to any other unproven therapy. Despite the presence of a drug, and in some cases, demonstrated efficacy in adults, it’s not clear that cough and cold products have any effectiveness in children. While most children tolerate these products well, mild side effects are not uncommon. Fatal side effects are exceptionally rare, but possible. Risks are greater in the younger child, and particularly in infants. We know that colds are generally mild and resolve on their own, and that no product has been demonstrated to have a meaningful effect on the duration of the cold. Rest, adequate fluid intake, and acetaminophen or ibuprofen for the feverish child may be all that is required. Steam humidification and saline nasal sprays may also offer some modest relief of clogged nasal passages.
Disclaimer : This post is NOT intended to give medical advice. If you or your child is unwell, please consult the doctor. The first three paras of this post is written based on my own experience.
