OTCs Today
Mary Warner
As parents of young children know, cold and flu bugs can run rampant through schools, day care centers, and whole communities. And when one child gets sick, it can spread like wildfire through the family until everyone is down with the flu or a cold. Unfortunately, options for treating colds and flu in children are limited.
Although most colds don’t cause serious complications, they can cause parents and caregivers to worry. It’s understandable to want to give medicine to a child to treat a cold or flu, but cough or cold medicine will not change the natural course of a cold or make it go away faster. In fact, these medications can have serious adverse effects.
Young children under 6 years
For kids under 6 years old with colds or flu, focus on symptom relief and TLC, rather than on medication. Children should be encouraged to rest and get plenty of sleep, though this can sometimes be difficult for active, small children. They should be offered plenty of fluids (e.g., water, juice, or broth) and encouraged to drink even if they say they’re not thirsty. Warm drinks can be soothing to a child with a sore throat, and saline nasal sprays or drops are helpful to make mucus easier to clear. Using a humidifier can relieve congestion.
The exception to the no medication rule for these small children is in regard to treating a fever. While a fever is generally a good sign that the body is fighting the virus, it can be dangerous for very young children. Parents should call their pediatrician if a child younger than 3 months old has a fever of 100.4 °F or higher and if a child younger than 24 months old has a fever of 102 °F or higher. For older children, fevers above 102 °F tend to cause discomfort and often require treatment with acetaminophen or ibuprofen. Pediatricians advise that there is generally no cause for concern as long as the child is responsive to those around them.
If acetaminophen or ibuprofen is warranted as a fever reducer or pain reliever, dosing guidelines should be followed closely. Dosage is based on weight and liquid medication should be carefully measured in a medication syringe or cup before giving it to the child. It should be noted that acetaminophen can be given to children more than 3 months old or weighing approximately 11 pounds or more; ibuprofen should not be given to children younger than 6 months old or those who have lost body fluid due to vomiting.
Children older than 6 years
Many adult cold/flu remedies are available in formulations that are suitable for children older than 6 years. Most of these combine active ingredients (e.g., antihistamine, decongestant, pain reliever, and cough suppressant). Examples include Children’s Dimetapp (brompheniramine maleate), Children’s Robitussin (chlorpheniramine maleate and dextromethorphan HBr), Children’s Sudafed PE (phenylephrine HCl and dextromethorphan HBr), Mucinex Children’s (dextromethorphan HBr, guaifenesin, and phenylephrine HCl), NyQuil (chlorpheniramine maleate, dextromethorphan HBr), DayQuil (dextromethorphan HBr, guaifenesin, phenylephrine HCl), and Children’s Sudafed Cold, Cough, Runny Nose (acetaminophen, chlorpheniramine maleate, dextromethorphan HBr).
Because these products contain ingredients that can lead to accidental overdosing, they can be harmful to children if they receive more than the recommended dose, take the medicine too often, or are given two products containing the same ingredient, such as a combination of cold medicine containing acetaminophen and a pain reliever also containing acetaminophen. Encourage caregivers to read the Drug Facts label on all medications and ensure that the medication is given using a medication cup or syringe marked with the correct measurements. Children should never be given medication that is packaged and made for adults because of the danger of overdose.
Homeopathic remedies
Most pharmacy shelves stock homeopathic products alongside FDA-approved medications for treating colds and flu in children. These products most often contain plant and mineral products, such as zinc, English ivy, turmeric, chamomile, antimonium tartaricum, allium cepa, dark honey, elderberry, and marshmallow root. There are no FDA-approved homeopathic products sold in the United States, and FDA urges that these products not be given to children younger than 4 years old because of possible serious adverse reactions, including seizure, allergic reaction, and difficulty breathing.
What to tell your patients
Advise patients to pay close attention to the ingredients in cold products and ensure that dosing is correct based on the child’s weight. Also remind parents to never give aspirin to children or teenagers because of the risk of Reye’s syndrome.
For further information, see Chapter 6 (Fever), Chapter 11 (Colds and Allergy), and Chapter 12 (Cough) in APhA’s Handbook of Nonprescription Drugs, 21st edition, available in the bookstore on pharmacist.com or the corresponding topic sections of APhA OTC on pharmacylibrary.com. ■