A Pharmacist's Tour of the Kid's Cough and Cold Aisle

Amanda S. has requested a guided tour of the children's cough and cold aisle--and you all get to come along! Step lightly here--this aisle is full of craziness.

If you’ve been paying attention you may have noticed the FDA making some serious changes to the labeling of kid’s cough and cold medicines. Almost every box on the aisle says it should not be used in children under 2 and a doctor should be consulted before using it in children under 4 (sometimes 6). For the most part, the parents I have explained this to quickly realize this is a conspiracy by the FDA to make children suffer thereby keeping their parents up all night thereby turning them into zombies the FDA can test anti-zombie vaccines on. Or something like that. As much as I would love for this to be true the real reason is slightly less interesting. 

First off, very few of the ingredients used in these products have been proven effective--even when all the researchers tried to prove was that the parents got more sleep. Shocking, yes? Secondly, although most of the products aren’t dangerous under proper use, there is so much duplication of ingredients among different products that it is easy for caregivers to accidentally overdose a child. As the FDA explains on their website, the label changes were made to reduce the risk of overdoses and to protect children from dangerous side effects. 

So we’re back to my favorite topic—risk vs. benefit. If you’re going to give your child something that has little to no benefit, how much risk are you willing to accept? (The correct answer is zero, in my humble opinion.) Also, do you really enjoy shelling out the big bucks for things that don’t work? (If you answered yes, please fill out the Ask the Pharmacist form with your bank account information. You are about to have the time of your life.)

In my youthful optimism of last week I decided I would go to my local grocery store and take pictures of all of the cough and cold products. I must have been delusional. My post-pregnancy mind had completely forgotten how out-of-control that cough and cold aisle is. The funniest part to me (sad pharmacist humor here) is that the bazillion different products on this aisle are just different mixtures of less than ten ingredients. Long-story-short I opted to save my sanity and my time and just explain the things that are worth your money.

PRECAUTIONS: Any child younger than 3 months should see a pediatrician before you start experimenting on them with cold remedies. For older children: read the dose and directions each time you give a medication and use only the measuring tool the product came with. (Or ask the pharmacist, they will be glad to give you an oral syringe.) NEVER guess/estimate doses or use a kitchen spoon to measure.

For congested and irritated noses give plenty of fluids (in their mouth)—this will help break up mucus. Feed infants frequently and give older children sips between meals. (Side note: have you ever noticed that it says to drink plenty of water while taking Mucinex®? Could this perhaps be what actually performs all the mucus-evicting miracles? Hmm…) 

Saline spray or drops in the nose followed by nasal bulb suction (the blue squeezy thing) can help clear heavy mucus. I will admit Little Miss is NOT a fan of drops in her nose or nasal suction but I know it doesn’t actually hurt her and she gets better at it the more often I do it. If all you can manage is getting the drops in that should still help soothe their little noses and thin out the mucus so it can move on down their throat—yum. You can do this a few times a day (basically whenever they need it and you have the gumption to do it). Wash the blue squeezy thing with soap and water after use. Plain saline drops are super cheap, FYI. 

Don’t be shocked but I am going to recommend something relatively expensive. The last time Little Miss was producing serious boogers I invested in some Boogie Wipes® and I totally loved them. One wipe and all the crusties were gone without irritating her nose. I would look for the unscented ones next time because I think the scent bugged her but other than that—two thumbs up.

I know a lot of people like humidifiers or vaporizers and they can help with congestion and coughing. I hesitate to use them because I feel like it takes more work than it is worth to keep them clean enough they aren’t just spraying bacteria around the room—yum. The EPA has some great suggestions on caring for humidifiers and I wouldn't necessarily discourage anyone from using one. 

Menthol products (aka the stinky petroleum your mom used to rub on your chest, or maybe your feet) give a sense of relief but any lasting efficacy has yet to be proven. Believe it or not, this is one of the more dangerous products on the cough and cold aisle. NEVER put menthol inside a child’s nostrils or even on their upper lip. Use it only on the chest and neck and cover with loose fitting clothing so children won’t play with it or eat it or get it in their eyes. If ingested, menthol can cause serious breathing, heart and nervous system problems. 

Plain jane acetaminophen (Tylenol®) can work wonders for any general achiness, fever or sore throat. (This is assuming you made sure the sore throat wasn’t strep. Not a good thing to ignore.) I wouldn’t recommend using the throat numbing sprays or cough drops on children—they need to be able to feel if they are choking. Cough drops are also really for older humans you can trust not to choke or drool red dye onto your favorite pillow. 

One of my favorite products on the cough and cold aisle (I like one! It’s a miracle!) is the honey based cough syrup. Honey is a natural cough suppressant that is possibly as or more effective than the cough suppressant dextromethorphan (Delsym®). As always, honey is not for children under 12 months of age. In children over 12 months, you can use any real honey and dose it as follows: 2-5 years old give ½ teaspoon 30 minutes before bedtime, 6-11 years old give 1 teaspoonful, 12-18 years old give 2 teaspoonfuls. There are also a few commercial products which might be slightly less messy (I hate measuring honey from the jar).  

And…that’s it. I just reduced an entire aisle to some saline drops, nose wipes, acetaminophen, and a little bottle of honey. I didn’t know I had it in me. Best of luck! (And wash those hands!)