In the Journals

Avoid suggesting OTC decongestants for kids this cold and flu season

Because no available evidence supports the use of over-the-counter decongestants and antihistamines in young children with the common cold, and the safety of these medications remains uncertain, the authors of an editorial published today in The BMJ asked providers to not encourage the use of these products in their pediatric patients.

Instead, the authors suggested reassuring patients and parents that these illnesses are self-limiting, and symptoms will resolve without treatment.

“Some products that contain decongestant may improve nasal symptoms in children, but their safety, especially in young children, is unclear,” Mieke L. van Driel, MD, PhD, MSc, chair in general practice at the University of Queensland, Australia, and colleagues wrote. “We did not find evidence to support the use of other common treatments and home remedies in children, including heated humidified air or steam, analgesics, echinacea, probiotics, herbs or vitamins.”

To support their position, the authors cited adverse events associated with decongestant use in children of varying ages, which include drowsiness, gastrointestinal upset, convulsions, rapid heart rate, and death.

This is especially important because children experience between six and eight colds annually. Van Driel and colleagues noted that colds can affect school attendance and health service use by children and result in unnecessary medication costs.

Boy blowing nose 
Experts said that there is no evidence to support the use of OTC decongestants and antihistamines in children with the common cold. Instead, providers should reassure patients that these illnesses are self-limiting.
Source: Shutterstock.com

For children aged younger than 12 years, some low-quality evidence points to saline irrigations being safe and possibly effective in young children. Other treatments, including decongestants and antihistamines, have contradicting data on their safety and efficacy at reducing nasal symptoms in this age group. Furthermore, using aromatic rubs to relieve congestion may result in skin rashes.

Currently, 17 clinical trials are evaluating medications and remedies to treat the common cold in children. These include analgesic-decongestant-antihistamine combinations (n = 3), an intranasal decongestant (n = 1), Chinese (n = 3) or other herbs (n = 4), herbal steam inhalation (n = 1), lactic acid bacteria (n = 1), pelargonium (n = 1), guaifenesin (n = 1) and antivirals (n = 2), according to the authors. These trials predominantly focus on adults, with four trials focused only on children and only one that includes participants of all ages. 

“Explain that a cold is distressing but should pass in 7 to 10 days,” van Driel and colleagues wrote. “If parents are concerned about their child’s comfort, saline nasal irrigations can be given to alleviate nasal symptoms.” – by Katherine Bortz

Disclosures: van Driel reports payment from IN VIVO Academy Ltd. to develop materials for an educational program on medication overuse for headache supported by a competitive unrestricted grant from Pfizer. Please see the editorial for all other authors’ relevant financial disclosures.

Because no available evidence supports the use of over-the-counter decongestants and antihistamines in young children with the common cold, and the safety of these medications remains uncertain, the authors of an editorial published today in The BMJ asked providers to not encourage the use of these products in their pediatric patients.

Instead, the authors suggested reassuring patients and parents that these illnesses are self-limiting, and symptoms will resolve without treatment.

“Some products that contain decongestant may improve nasal symptoms in children, but their safety, especially in young children, is unclear,” Mieke L. van Driel, MD, PhD, MSc, chair in general practice at the University of Queensland, Australia, and colleagues wrote. “We did not find evidence to support the use of other common treatments and home remedies in children, including heated humidified air or steam, analgesics, echinacea, probiotics, herbs or vitamins.”

To support their position, the authors cited adverse events associated with decongestant use in children of varying ages, which include drowsiness, gastrointestinal upset, convulsions, rapid heart rate, and death.

This is especially important because children experience between six and eight colds annually. Van Driel and colleagues noted that colds can affect school attendance and health service use by children and result in unnecessary medication costs.

Boy blowing nose 
Experts said that there is no evidence to support the use of OTC decongestants and antihistamines in children with the common cold. Instead, providers should reassure patients that these illnesses are self-limiting.
Source: Shutterstock.com

For children aged younger than 12 years, some low-quality evidence points to saline irrigations being safe and possibly effective in young children. Other treatments, including decongestants and antihistamines, have contradicting data on their safety and efficacy at reducing nasal symptoms in this age group. Furthermore, using aromatic rubs to relieve congestion may result in skin rashes.

Currently, 17 clinical trials are evaluating medications and remedies to treat the common cold in children. These include analgesic-decongestant-antihistamine combinations (n = 3), an intranasal decongestant (n = 1), Chinese (n = 3) or other herbs (n = 4), herbal steam inhalation (n = 1), lactic acid bacteria (n = 1), pelargonium (n = 1), guaifenesin (n = 1) and antivirals (n = 2), according to the authors. These trials predominantly focus on adults, with four trials focused only on children and only one that includes participants of all ages. 

“Explain that a cold is distressing but should pass in 7 to 10 days,” van Driel and colleagues wrote. “If parents are concerned about their child’s comfort, saline nasal irrigations can be given to alleviate nasal symptoms.” – by Katherine Bortz

Disclosures: van Driel reports payment from IN VIVO Academy Ltd. to develop materials for an educational program on medication overuse for headache supported by a competitive unrestricted grant from Pfizer. Please see the editorial for all other authors’ relevant financial disclosures.