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Treating Cough in Children with Common Cold-Guidance to Caregivers

Home >> Blogs >> Paediatric >> Treating Cough in Children with Common Cold-Guidance to Caregivers

Clinical Directorate

Cough and Cold

Treating Cough in Children with Common Cold-Guidance to Caregivers

Coughing is a prevalent symptom of upper respiratory infections (URIs). Cough causes concern for parents and is also a major cause of outpatient visits. It can severely impact quality of life, cause anxiety and affect sleep in parents and children. Despite the widespread use of over-the-counter (OTC) cough and cold medications (CCMs), the effectiveness of most OTC CCMs has not been proven in children. The preparations are usually a combination of several medications including antitussives, expectorants, antihistamines, decongestants and antipyretics such as acetaminophen. Since the first approval for use of CCMs in 1976, no data supporting the safety and efficacy in children were available and dosing recommendations were derived using adult dosing. Food And Drug Administration (FDA) reviewed this approval in 2007. The effectiveness of most CCMs has not been proven in children. On the contrary, CCMs have been associated with some potential harm.

Factors associated with fatalities from OTC CCMs are:

  • Age younger than 2 years,
  • Use of medication for sedation 
  • Use in a daycare setting
  • Combining two or more medications with the same ingredient
  • Failure to use a measuring device
  • Product misidentification
  • Use of product intended for adults. The FDA recommended that CCMs should not be used in children less than 2 years of age and Health Canada advised against the use of all CCM formulations in children younger than six years of age since the fall of 2008.

What other measures can families do to support children with cough and cold symptoms likely due to a viral illness?

  • Fluid intake- Consumption of fluids during an illness with cough and cold is considered the mainstay of treatment in children. Staying hydrated and softening secretions are the mechanisms of benefit.
  • Humidified air- Humidified air (cold or warm) is recommended for use. The mechanism of action is unclear and may involve enhanced drainage of congested upper airways.
  • Honey- Pasteurized honey can safely be used in children older than one year of age. It is inexpensive, has an excellent safety profile, a good demulcent effect and antioxidant properties. Honey before sleep has proven to improve cough frequency and severity as well as sleep quality compared with dextromethorphan, diphenhydramine or placebo. Despite their widespread use among children, the use of OTC CCMs is not effective in most cases and is potentially harmful. Alternatives as fluid, humidified air, zinc and vitamin C have been investigated. Honey may have beneficial effects but dosing is yet to be determined. These alternative measures seem justifiable for large number of children suffering from common cold.