Thoughts for Tots: To Treat or Not to Treat...That is the Question!

'Tis the season to feel yucky! Keep your kids healthy with good hygiene practices. When this fails...consider what you are putting into your child before you run to the store to fix that cough or runny nose. It must be safe, right?....it's over-the-counter! Well, here is everything you wanted to know (and more) about chillins, bugs and drugs.

The manufacturer of some very common cough and cold products for children have voluntarily withdrawn some of their combination products. This is not due to their questionable safety but to the misuse patterns that lead to overdose and in some cases death...particularly in children younger than two years. See the list in the right hand column for medications recalled.

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The Real Scoop...

As pharmacists, we do not recommend the use of cough and cold products in children younger than two years old because they have not proven to be effective and have caused severe adverse effects. In this case, the risks outweigh the benefits. Here is why.

There is very limited data on the efficacy of these products and the data we do have show no evidence that OTC cough and cold medicines are effective in children.

Schroeder and Fahey looked at 7 trials of cough and cold products in children. All studies showed that antitussives (codeine and dextromethorphan), antihistamines (diphenhydramine, bromopheniramine, and chlorpheniramine), and antihistamine-decongestant combos were no more effective than placebo in treating cold symptoms. Expectorants (guaifenesin) did show mild improvement over placebo for children with a productive cough.

The potential side effects of these medications in the case of an accidental overdose include increased heart rate, muscle coordination disorders, nystagmus (involuntary rapid movement of the eyeball) and in extreme cases can cause the heart to stop and/or result in death.

The Pediatrician's Accrediting Body has come to the same conclusion not to use cough and cold products in children less than 2 years.

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Fever

Believe it or not...fevers are great! It is our body's way of burning the heck out of bugs inside us! Let the child's body do its job as long as they (or mom) can tolerate it. (Don't forget to hydrate!)

There are certain instances, however, when we do get concerned about fever.

1. If the temperature increases rapidly...because fevers can trigger seizures in small children (<5)
2. If the fever is greater than 103.1 F. Above this Temp...all bets are off. The fever is no longer beneficial.
3. If the infant is less than 3 months old.

What kind of thermometer is the best?...

Please throw away the cool space technology such as the infared forehead swipey thing...if you have it...do an experiment. First, try it right against your hairline. Now...try it just above your eyebrows. Fancy that...there is about a 10 degree difference there...just about the difference between being hypothermic and burning necrotic...just kidding...sort of....just don't use them. Sorry to say it, but tympanic is also not very reliable.

The most accurate of all thermometers is...drum roll please...the rectal one! Yay! Next in line is the oral, so depending on the age...choose one of these! :)

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Blah...Blah...Blah...So when do I use what?

My first recommendation to all parents is to invest in a cold humidifier. Hydration is key! Keep the fluids coming...especially if the child has a fever. Bulb suction of nares or saline nasal spray may also provide relief.

Tylenol (acetaminophen) and Motrin (ibuprofen) are both excellent choices to treat runny noses and coughs. They are relatively safe with minimal side effects. Ibuprofen may cause a little more upset stomach but may help the aches and runny nose better than Tylenol. Tylenol is usually better tolerated and does the trick for fevers (only if you need to treat of course!), sore throat and earaches.

Mucinex (guaifenesin) may be a good choice if the child has a productive cough. It will help break up the mucus so it can come up and out!

NO Pepto Bismol or aspirin!!! Salicylates can cause a severe disorder known as Reye's syndrome or even death.

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Safety Tips and Tricks

• A single caregiver should administer medicine (prevents accidental duplicate dosing).
• Only use a single medicine.
• Use an appropriate measuring device (silverware is not an appropriate measuring device!). The pharmacy will have these for you if you need one...just ask.
• Use only the correct formulation. Adult vs Pediatric vs Infant...they are all different. Do not use the adult formulation.
• Follow the instructions exactly as indicated on the box or as directed by a healthcare provider.

When to go to the Doctor

1. If an infant less than 3 months gets a fever
2. Children with a fever over 103 F.
3. Fevers that last longer than 3 days.
4. Any child with febrile seizures or stiff necks should go to the ER immediately.

Don't forget...use of these products does not help the cold go away faster; it just treats symptoms. Weigh the risks to benefits before taking any medication, especially for children.