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Coughs and Colds in Kids: A Doctor's Advice

There's a reason the FDA is cracking down on some cough medicines

By Henry J. Fishman, M.D.
ConsumerAffairs.com

October 1, 2007

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It's 2 a.m. Your three-year-old is coughing, sneezing and hacking up a storm. The kid needs to get some sleep, and so do you.

Guess it's time to reach for your tried and true, multi-symptom, one-product-cures-everything, over-the-counter cold and cough formula.

Or is it?

The Food and Drug Administration says maybe not. It is considering taking hydrocodone, a powerful prescription cough suppressant, off the market, along with a lot of the over-the-counter cold, cough and allergy products for kids that use hydrocodone in small amounts.

How come? Well hydrocodone is a powerful narcotic. And truth be told, not a single study shows it works in kids. Not only that, it can cause serious side effects, even addiction.

Most of the time you're better off talking to your doctor first, treating the underlying cause of your child’s cough, and skipping narcotic cough suppressants, which just treat symptoms.

Ditto for the multi-symptom five-in-one cocktails you get over the counter. They can have five or six drugs at a time, when your child just needs one or two. Not a single OTC multi-symptom cough or cold medicine has been adequately tested in kids under 6 and frankly, a lot of the stuff does not work.

For example, there are few if any studies to show that dextromethorphan, a semi-synthetic narcotic analogue suppresses coughs. There is little to show that guaifenesin, a mucous thinner and expectorant, does what it says. Finally, multi-symptom products cause lots of side effects. Some teenagers even use them to get high.

What to do

So what’s a parent to do? Here are some suggestions:

1. Call your doctor when your child is sick.

2. Discuss the benefits and risk of prescription and OTC medicines.

3. Ask if the medicine you are thinking about using is proven safe and effective in kids.

4. Find out what the underlying cause of your child’s symptoms is and treat the cause, don’t just suppress the cough. For example, treat the cough of asthma with asthma medications, pneumonia with antibiotics.

5. If you go the OTC route, use single agent medicines. They have not been tested in kids under 6 but have passed the test of time. Most have been around for years. For example, Phenylephrine and Sudafed work for congestion, though Sudafed is now behind the counter, so you have to ask for it. OTC nose sprays can be used for a few days. Antihistamines help allergies, not colds.

6. You should usually use acetaminophen for aches and pains. Aspirin and non steroidal anti-inflammatories can combine with viruses to cause a rare but potentially dangerous problem called Reyes Syndrome.

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