Cold medicines for kids: What's the risk?

Jay Hoecker, M.D.

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Over-the-counter cough and cold medicines are the best way to help a child who has a cold feel better — right? Think again. Cough and cold medicines aren't recommended for children younger than age 2, and the jury is still out on whether cough and cold medicines are appropriate for older kids. So how can you treat a child's cold? Here's practical advice from Jay Hoecker, M.D., a pediatrics specialist at Mayo Clinic, Rochester, Minn.

What's the concern about cough and cold medicines for kids?

Over-the-counter cough and cold medicines don't effectively treat the underlying cause of a child's cold, and won't cure a child's cold or make it go away any sooner. These medications also have potential side effects, including rapid heart rate and convulsions. The Food and Drug Administration (FDA) recommends that parents avoid using cough and cold medicines to treat children younger than age 2.

Are cough and cold medicines a problem for children older than age 2?

FDA experts are studying the safety of cough and cold medicines for children older than age 2. In the meantime, remember that cough and cold medicines won't make a cold go away any sooner — and side effects are still possible. If you give cough or cold medicines to an older child, carefully follow the label directions. Don't give your child two medicines with the same active ingredient, such as an antihistamine, decongestant or pain reliever. Too much of a single ingredient could lead to an accidental overdose.

What about antibiotics?

Antibiotics may be used to combat bacterial infections but have no effect on viruses, which cause colds. If your child has a cold, antibiotics won't help. It's also important to remember that the more your child uses antibiotics, the more likely he or she is to get sick with an antibiotic-resistant infection in the future.

Can any medications help treat the common cold?

An over-the-counter pain reliever — such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) — can reduce a fever and ease the pain of a sore throat or headache. If you give your child a pain reliever, follow the dosing guidelines carefully.

Don't give ibuprofen to a child younger than age 6 months or to a child who is dehydrated or vomiting continuously, and don't give aspirin to anyone age 18 or younger. Aspirin has been associated with Reye's syndrome, a rare but potentially fatal illness.

If you want to give your child an herbal or alternative remedy, consult your child's doctor first.

How can I help my child feel better?

There's no cure for the common cold, but you can help your child feel better while he or she is toughing it out.

• Offer fluids. Liquids such as water, juice and broth can help loosen congestion.
• Encourage coughing. Coughing can help clear mucus from your child's airway. If your child needs help coughing, place your child on your lap, lean his or her body forward about 30 degrees, and gently tap his or her back.
• Use a suction bulb for a baby or young child. This device draws mucus out of the nose. Squeeze the bulb part of the syringe, gently place the tip inside one nostril and slowly release the bulb.
• Moisten nasal passages. Run a cool-mist humidifier in your child's room. To prevent mold growth, change the water daily and follow the manufacturer's cleaning instructions. Steam from a hot shower may help, too. Over-the-counter saline nose drops also can loosen thick nasal mucus and make it easier for your child to breathe. For babies, follow up with a suction bulb.
• Soothe a sore throat. For a child older than age 4, gargling salt water or sucking on hard candy or cough drops may soothe a sore throat. Honey also may help relieve a cough. Try 1/2 teaspoon (2.5 milliliters) for children ages 2 to 5, 1 teaspoon (5 milliliters) for children ages 6 to 11 and 2 teaspoons (10 milliliters) for children age 12 and older. Due to the risk of infant botulism, a rare but serious form of food poisoning, never give honey to a child younger than age 1.
• Encourage rest. Consider keeping your child home from school and other activities if he or she has a fever or bad cough.

When should I contact the doctor?

Most colds simply need to run their course. It's important to take your child's signs and symptoms seriously, however. If you have a baby who's younger than age 3 months, contact the doctor at the first sign of illness. For newborns, a common cold can quickly develop into croup, pneumonia or another serious illness.

Otherwise, contact the doctor if your child:

• Isn't urinating as often as usual
• Has a temperature higher than 103 F (39.4 C) for one day
• Has a temperature higher than 100 F (37.8 C) for more than three days
• Seems to have ear or sinus pain
• Has yellow eye discharge
• Has a cough for longer than one week
• Has thick, green nasal discharge

Seek medical help immediately if your child:

• Has trouble drinking
• Coughs hard enough to cause vomiting or changes in skin color
• Coughs up blood-tinged sputum
• Has difficulty breathing or is bluish around the lips and mouth

What's the best way to prevent the common cold?

The common cold typically spreads through infected respiratory droplets coughed or sneezed into the air. To help your child stay healthy:

• Keep it clean. Teach your child to wash his or her hands thoroughly and often. When soap and water aren't available, provide an alcohol-based hand sanitizer or hand wipes. Keep toys and common household surfaces clean, too.
• Cover up. Teach everyone in the household to cough or sneeze into a tissue — and then toss it. If you can't reach a tissue in time, cough or sneeze into the crook of your arm.
• Don't share. Avoid sharing utensils, drinking glasses, washcloths, towels and other items that may harbor germs with anyone who has a cold or fever.
• Avoid anyone who's sick. This is especially important during the first few days of a viral illness, when the person who's sick may be most contagious.

For parents and children alike, simple preventive measures can go a long way toward preventing the common cold.