Why You Shouldn’t Give Decongestants to Children

For many years parents (myself included) have a tough time dealing with feelings of helplessness, while their child or children endure the symptoms while waiting for the cold to run its course (which can take 7-10 days). This is especially true for parents of young children who are much more sensitive to pain and discomfort and typically have 6-8 colds per year vs adults who usually have 2-4 colds per year (Gwaltney, 2002; Witek, Ramsey, Carr, and Riker, 2015).   For many years, such parents have been treating their young, often very uncomfortable children’s cold symptoms with over-the-counter (OTC) medications.  These are often recommended by Pediatricians as a means to relieve some of the symptomology allowing for improved sleep, and an increased level of comfortability for the child.

One such type of medication that has been recommended and utilized by parents to help their young children are decongestants.  Children’s decongestants come in a wide variety of brands and flavors (think bubblegum, cherry, grape, and many more) helping the child ingest the medication.  While these medications do help to reduce some such symptoms, providing much needed relief as well as sleep for both the child and the parent(s), experts have now concluded that decongestants should not be given to children younger than age 6 and if given to children younger than 12, it should be done so with caution. Although thought to be helpful, “there is no evidence of these products alleviate nasal symptoms in young children and there is evidence they cause adverse effects that include drowsiness and gastrointestinal upset,” wrote a group of physicians lead by Mieke van Driel, MD, PhD, Head, Primary Care Clinical Unit & Head, Faculty of Medicine at the University of Queensland, Australia (BMJ, 2018).

In addition, the use of these drugs has been associated with more serious events, such as convulsions, rapid heart rate, and death, in very young children.  These warnings have existed for over a decade when the FDA issued a public health advisory stating that OTC cough and cold products should not be used to treat children under age 2.  The FDA stated with their now 10 year old public health advisory, that they were investigating use of these medications on children ages 2-11, but have yet to issue any of their findings to date.  This has likely left both pediatricians and parents with the message that such medications are safe for use with children ages 2-11.

No Evidence of Benefit in Children

 

 

 

 

 

 

 

 

 

 

What Should Be Done:
According to Michelle Terry, MD, a pediatrician at Seattle Children’s Hospital, the researcher’s conclusions are in line with her experience at that of her colleagues, and has some recommendations.  Dr. Terry in her agreement with the researchers of the meta-analysis of many studies stated, “There is no evidence that decongestants or antihistamines shorten the duration or significantly improve the symptoms of the common cold in children. Reassuring patients and parents that these illnesses are self-limiting is the preferred therapy offered by pediatricians.” She continued, adding that “pediatricians should also review with the parents the potential signs and symptoms of respiratory distress in their children so that parents know when a cold has become more serious and requires physician attention.”

 

Recommendations by the Researchers at the British Journal of Medicine (BMJ):

  • Children under 12 not should not be given decongestants “as evidence of their effectiveness is limited and associated risks may exist” (
  • They do not recommend decongestant or formulations containing antihistamine in children under 6 and advise caution between 6 and 12 years.
    • There is no evidence that these treatments alleviate nasal symptoms and they can cause adverse effects such as drowsiness or gastrointestinal upset.
    • Serious harm, such as convulsions, rapid heart rate and death have been linked to decongestant use in very young children.
    • None of the other commonly used OTC and home treatments, such as heated humidified air, eucalyptus oil, or echinacea are supported by adequate evidence.
  • Parents should be receive information from their child’s pediatrician, explaining that a cold is distressing but should pass in 7-10 days.
  • If parents are especially concerned due to their child’s high level of discomfort, saline nasal irrigations can be given to alleviate nasal symptoms.

Fig. 1: Benefit & Harm of Common Cold Treatments in Children
A Summary Based on the Analysis of the Evidence from the Cochrane Reviews and Clinical Trials

“No effect” indicates that data were pooled and the overall effect estimate was not statistically significant.
A “possible” effect is based on a qualitative appreciation of the effects reported in individual trails that could not be pooled.
Interpretation of the size of the effect was based on what the authors reported and on the Cochrane Handbook (eg a standard mean difference of 0.2 to 0.49 represents a small, 0.5 to 0.79 a moderate, and ≥0.8 a large clinical effect).
If no pooling was available but results were consistent, it was concluded that there was a possible effect or possibly no effect.
The Cochrane review on antivirals has been withdrawn, no new updated Cochrane review has been published.
†The Cochrane review on fluid intake did not identify and relevant trials.

 

References

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k3786 (Published 10 October 2018).

Gwaltney, J.M. (2002). Clinical significance and pathogenesis of viral respriratory infections. Am Journal of Medicine,112(6),135-185.
doi: 10.1016/S0002-9343(01)01059-2.

Witek, T.J,, Ramsey, D.L., Carr, A.N,, & Riker, D.K. (2015). The natural history of community-acquired common colds symptoms assessed over 4-years. Rhinology,;53, 81-88.
doi:10.4193/Rhin14.149 pmid:25756083.

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