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February 27, 2008 > When the Risks Outweigh the Benefits: Pediatric Hospitalist Talks Frankly About Kids' Cold and Cough Medicines

When the Risks Outweigh the Benefits: Pediatric Hospitalist Talks Frankly About Kids' Cold and Cough Medicines

Dr. Kim Horstman, a pediatric hospitalist at Washington Hospital, knows how uncomfortable it can be for parents to watch their young children suffer - even just a little bit.
But sometimes this anxiety can lead to dangerous decisions, even with something as minor as the common cold.
"It's difficult for parents to see their children suffering, even if it's just from a stuffy nose, and they'll often do anything in their power to alleviate that suffering," Dr. Horstman relates. "Unfortunately this often includes giving doses of multiple cold preparations at the same time, or giving excessive doses until they perceive the symptoms are improved - this is really where the greatest danger lies."
Very recently, the Food and Drug Administration (FDA) issued a warning to parents of children under 2 declaring over-the-counter cold and cough medications dangerous.
The announcement came after drug companies last October quit selling dozens of versions of OTC cold remedies targeted specifically to babies and toddlers. The agency's scientific advisers also voted that the drugs don't work in small children and shouldn't be used in anyone under age 6.
Side effects outweigh benefits
"The concern with administering cold and cough medications to children under two is that they are much less able to tolerate the potential side effects of these medicines," according to Dr. Horstman. "The decongestant component of the medicines can cause increased heart rate and blood pressure, and the antihistamine component can cause sedation, which can lead to slowed breathing and an inability to prevent choking in the event of vomiting. In 2005, there were three documented deaths from taking cold medicines in children under the age of six months. During that same year over a thousand children were seen in emergency rooms for problems directly associated with side effects from these medications."
The real irony, according to Horstman, is that numerous clinical studies have shown that they're no more effective at fighting cold and cough symptoms than placebos, which contain only inert, or inactive, ingredients.
"The fact is that most colds have a predictable course with gradual resolution, and the perceived effectiveness of the medications is likely to be symptom improvement associated with the natural course of the illness," she says. "Also, colds in general are seen as a fairly benign but annoying thing, so it's probably hard for some parents to grasp that the treatment could be any worse that the illness."
Staying informed
Parents may inadvertently expose their children to potential dangerous side effects from these medications for a variety of reasons, she says.
One reason is that a number of medications aimed at relieving cold and cough symptoms may contain several ingredients. Without carefully checking the product labeling or talking to their child's pediatrician, parents might not realize that by giving two or three medications for symptoms, they're actually doubling or tripling the medication dosages.
"This is, by far, the main cause of side effects and death with these medications," Dr. Horstman says.
Unlike adults, who are more capable of determining if they are suffering side effects from medications, children may not being able to communicate if something is not right, making them more likely to suffer an overdose or other potential side effect of the drugs.
Dr. Horstman adds, "Some children's cough and cold medication is dosed by age, but this doesn't take into account the varying weights of kids the same age - this most definitely can lead to overdose."
If parents have questions about the proper dosing of a particular medication or are unsure if it is safe, Dr. Horstman says they should definitely get in touch with their child's pediatrician to clear up any confusion before giving their child any medication.
Because, unlike prescription medications, children's cold and cough medicines are sold without a prescription, they can actually be more dangerous - since they are many times administered without the supervision of a physician, according to Horstman.
What parents can do
To avoid medication-related complications, she has several recommendations for parents whose children are suffering from cold and cough symptoms.
"Both Tylenol (acetaminophen) and Motrin or Advil (ibuprofen) are both safe and effective for fever reduction when taken in the recommended dosage and frequency," she explains. "They have not been shown to cause any of the physiologic changes like increased heart rate, blood pressure or sedation."
Because they work in different ways, acetaminophen and ibuprofen can be taken on an alternating schedule every three hours, she says. This means the child is actually getting each medication every six hours, which is within the recommended dosing frequency for both medications, according to Dr. Horstman. Alternating medications in this manner will often make the child feel better as the natural course of the illness progresses.
To control nasal congestion, parents can give their children saline nasal drops, which she says are completely safe. Alternating Tylenol and Motrin will also help control fever and body aches until the illness passes.
Overall, the best course of action for parents is to keep their children well hydrated and make sure they get plenty of rest to help them recover. When it comes to giving kids medicine for the common cold, Horstman says it's better to be safe than sorry.
"If parents really feel like they need to give medications for the symptoms, they should look at and write down each component of each medication they intend to administer to make sure that there's no overlap," she says. "If there's any question about an ingredient, call your pediatrician before giving the medication."
Dr. Horstman is a member of a medical team that staffs Washington Hospital 24-hours a day, seven days a week, providing seamless care for pediatric patients admitted to the hospital. She and her colleagues see infants and children in all areas of the hospital and perform Well Baby checks for newborns.

Learn More About Pediatrics on InHealth Channel 78
You can learn more about pediatric health on two new television programs on InHealth, a Washington Hospital Channel on Comcast 78. "Inside Washington Hospital: Pediatric Care" and "Your Concerns InHealth: Pediatric Care - The Pre-School Years" give viewers an inside look at Washington Hospital's pediatrics department. Both programs also take an in-depth look at child related health topics and feature some of the local pediatricians in our community. The InHealth program schedule is published weekly in this section of the Tri-City Voice and the schedule is also posted on Washington Hospital's website at InHealth Channel 78 is available to Comcast subscribers in Newark, Union City and Fremont.

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