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Making Sense of Kids' Medicines

Your 10-year-old feels miserable. He's got a runny nose, cough, and fever--all signs of the common cold going around his class in school. The pediatrician says it could take as long as 14 days to clear up and recommends a decongestant to unstuff your son's nose. But then the pharmacist advises a suppressant to curb the cough. What's a parent to do?

Selecting the right over-the-counter medicine for your child's cold or flu can be tricky. Especially since there's more than 30 different combination formulas, an array of unpronounceable ingredients, and confusing similarities between store and brand name products.

How do you choose?

"Stick to single ingredient products whenever possible, and limit medication to the one that will relieve the symptom that troubles your child most," says Ralph Kauffman, MD., professor of pediatrics and pharmacology at the University of Missouri School of Medicine in Kansas City.

Dr. Kauffman's advice: If you're thinking about giving two drugs simultaneously, call your doctor first. That way, you won't give your child a medication he doesn't need, or inadvertently give him an overdose by giving two or more combination products that contain the same ingredients.

For stuffy nose and cough

Most doctors advise using a decongestant to unclog nasal stuffiness and a separate analgesic to relieve fever and aches. But coughs can be trickier to treat. An expectorant -- frequently sold in combination with a suppressant -- can quiet a dry, hacking cough and loosen thick mucus in the lungs so it can be expelled. A cough suppressant can be used at bedtime to buy your child some much-needed rest.

Medications to avoid

Stay away from decongestant nose drops or sprays; they can often cause a rebound effect with prolonged use for more than three days, which makes congestion worse. Instead, use saline nose drops, which are safer.

And skip the daytime over-the-counter formulas that contain antihistamines, which have little value for colds and work only for allergies (sneezing, runny nose and congestion without fever). Antihistamines may cause drowsiness or excitability, which won't help your child in school. What's more, they can actually thicken mucus in children with underlying respiratory conditions like asthma.

Brand versus store name medications

In most cases, price and taste are the only difference between brand-name and generic cold remedies, says Dr. Kauffman. But always check the active and inactive ingredients, and also read dosage levels on the labels. Some children may develop a rash or show changes in behavior in reaction to certain dyes in medication. Others may have stomach cramping or diarrhea if they are intolerant to the lactose often used to sweeten liquid products.

Drugs you should never give to your child:

  • Aspirin is linked to a dangerous liver disease called Reye's syndrome. Never give it to kids under 18 unless prescribed by your doctor.
  • Camphor-containing products such as Vicks VapoRub can cause convulsions in children if accidentally ingested or absorbed through the nose. Never use on children under two years of age, and apply only on the chest -never the face - of older kids.
  • Menthol- or eucalyptus-containing ointments are readily absorbed through the skin into the bloodstream and can be toxic in babies and children under two years of age. Never rub on your child's skin or put it in a vaporizer.
  • Anesthetic throat spray may suppress the gag reflex and allow a child (especially under age six) to choke, particularly when sleeping.
What do those ingredients really do?

  • Analgesics relieve minor aches, headaches, muscle pain, and post-immunization reactions.
  • Antipyretics are medications designed to reduce fever.
  • Antihistamines dry up secretions of the respiratory tract and can minimize allergy symptoms. They are rarely effective against colds.
  • Decongestants help unclog nasal passages and clear congestion.
  • Expectorants help loosen mucus in the lungs so it can be coughed up and expelled.
  • Supressants, or antitussives, relieve the irritation of dry, unproductive coughs. Suppressing a cough for several days may cause a buildup of mucus in the lungs, so these drugs should not be used for prolonged periods.
Cold remedies that really work

For stuffy nose, and sinus congestion: pseudoephedrine
    Brand name: Children's Sudafed, Triaminic AM, Dimetapp Decongestant Pediatric Drops
    Note: Do not use in children under two years of age; if hyperactivity or sleeplessness occurs; or if the child has heart, thyroid disease, high blood pressure, or diabetes.

For dry, irritating unproductive cough: dextromethorphan
    Brand names: Pediatric Vicks 44 or 44E, Robitussin DM, Benylin Cough Suppressant Expectorant
    Note: Do not use if the child is under two years of age; if the child coughs up excessive mucus; if mucus is green or yellow; if the child has asthma; or if the child is taking prescription drugs for a psychiatric disorder.

For loose, productive cough: guaifenesin
    Brand name: Robitussin Pediatric Cough Suppressant
    Note: Do not use if the child is under two years of age; if mucus is excessive, green or yellow; or if drugs are being given for a psychiatric disorder.

For fever and sore throat: ibuprofen
    Brand name: Children's Motrin
    Note: Do not use if the child is under two years of age; if pain or fever persists more than three days; or if the child is dehydrated due to vomiting or fever.

For fever and sore throat: acetaminophen
    Brand name: Children's Tylenol
    Note: Do not use if the child is under two years of age; if pain or fever persists more than three days; or if the child is dehydrated due to vomiting or fever.

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