Treatment of Coughs and Colds in Children

Pharmacy Times, Volume 0, 0

Most young children will have 8 to 10 colds in their first 2 years, compared with 3 colds in adults.(1)The good news is that the common cold is a self-limiting illness with a favorable prognosis. A cold is caused by a viral infection that typically lasts less than a week. Unfortunately, science has not found a cure for the common cold?or even a way to shorten the illness. In this day of high-tech knowledge, medicine can offer only relief of the symptoms of a cold. No cure is available, so the virus infection must simply run its course.

Cold Prevention

More important than treatment of a cold is prevention. The virus that causes the common cold is transferred in a variety of ways. It may spread through water droplets or mucus expelled during a sneeze or cough. It will also spread when an infected person?s hand becomes contaminated during coughing, sneezing, or touching the nose. If the person?s hand then comes into contact with a healthy person, he or she will become contaminated.

Young children are particularly susceptible to viral infections because they have not developed an immunity to them. To prevent the spread of infection, frequent hand washing is recommended, along with the use of tissues when sneezing or coughing.

When to Seek Medical Attention

Along with knowing how to prevent a cold, it is very important to know when to seek medical help. If the child is under 3 months old, the child?s physician should be contacted as soon as symptoms develop. Infections in small babies can quickly develop into something more serious. For children over 3 months old, medical care should be sought if:

? The fever lasts for more than 3 days or is over 102?F

? The cough lasts for more than 1 to 2 weeks

? The lips or nails turn blue

? The child has difficulty breathing

? The eyes develop a yellow discharge

? The child complains of ear pain

? Despite suctioning, the nose remains too blocked for the infant to drink

? Pus or spots appear in the throat

? The child is experiencing febrile seizures

Treatment When Medical Attention Is Not Necessary

When medical care is not necessary, many options are available to relieve the symptoms of the common cold. Because children are more susceptible to side effects from medications, it is important to try nonmedical treatments first. While the child is sick, bed rest, plenty of fluids, and a well-balanced diet should be encouraged. Maintaining a normal schedule is not as important as letting the child rest as much as needed.

For the reduction of fever, parents can sponge bathe the child with lukewarm, not cold, water. The evaporation of the water will create a cooling sensation on the skin and draw the heat to the surface. Acetaminophen and ibuprofen also are recommended for the reduction of fever due to the common cold. Although the clinical significance is not known, studies have shown that acetaminophen and aspirin alter the course of the cold, and ibuprofen does not. Acetamin-ophen prolongs viral shedding, and ibuprofen does not.(2)Ibuprofen is not approved for use in children under the age of 6 months. Aspirin should never be used in children or teenagers who have a cold because of the risk of Reye?s syndrome, a central nervous system disorder that is often fatal.

A runny nose is the body?s way of getting rid of the virus. For a runny nose, the best treatment is clearing the nose of mucus. This is accomplished through blowing. For a younger child who cannot blow his or her nose, suctioning with a soft rubber bulb is appropriate. To suction, squeeze the bulb before placing it in the child?s nose, gently stick the tip into the nostril, close off the other nostril, and slowly release the bulb.

Although antihistamines are often used for the relief of runny nose due to allergies, clinical studies do not support their use against the common cold. Moreover, the use of antihistamines in small children is contraindi-cated without a doctor?s recommendation. A stuffy nose is often caused by swollen membranes and dry mucus. Although everyone considers a stuffed nose inconvenient, this is especially problematic for small children. Infants are unable to suck on a bottle or pacifier if they are unable to breathe out of their nose. Blowing and suctioning are often ineffective. Warm tap water or saline is effective as a decongestant and for loosening dried mucus. For children who are unable to blow their nose, place 3 drops of water or saline in each nostril, then suction after 1 minute. For older children, place 3 drops into each nostril while the child is lying on his or her back with his or her head hanging off the bed. After 1 minute, the child can blow his or her nose. This procedure can be repeated several times since there is no risk of overdose or side effects. Performing this procedure before feedings and at bedtime will help the child to eat and sleep.

Another effective treatment for a stuffy nose is a cool-mist vaporizer. The vaporizer increases the humidity in the air, thus helping to thin mucus and clear nasal passages. Parents need to clean out and change the water in the vaporizer daily to avoid mold growth. If a cool-mist vaporizer is not available, the steam from a shower can be used. Parents should avoid hot-mist vaporizers due to the risk of burns.

If an OTC medication is necessary to relieve a stuffed nose, oral pseudo-ephedrine and phenylephrine sprays or drops are available. Long-acting oxymetazoline should be avoided. Children under 6 years old should not receive aromatic inhalants. The topical formulations are indicated for 3 days of use, whereas the oral formulations are approved for 7 days.

Coughing helps expel secretions from the lungs but can be annoying to the patient. Children over the age of 4 years can usually suck on cough lozenges or hard candy with minimal risk of choking. For smaller children, some sources recommend a homemade cough syrup consisting of 1/2to 1 teaspoon of corn syrup.(3)Coughing spasms in children over 4 months old are easily controlled by having them drink warm liquids, such as lemonade, apple juice, unsalted broth, or decaffeinated tea. The warm liquid relaxes the airway and loosens mucus. Children less than 1 year old should not receive honey in their warmed liquid because of the risk of bacterial growth in the honey. Alcohol should never be added to the child?s drink.

Guaifenesin, an expectorant, and dextromethorphan, an antitussive, are common ingredients in cough preparations. The effectiveness of these agents continues to be questioned due to a lack of clinical data supporting their use. Menthol, as a topical ointment or patch, is also approved as an antitussive agent. Parents should be aware that menthol causes skin irritation. Because of reports of spontaneous respiratory collapse, menthol rubs are not recommended for children less than 2 years old.


Despite the anxiety associated with caring for an ill child, it is important to remember that this viral infection will resolve quickly. Antibiotics do not play a role in the treatment of the common cold. Only a small number of cases progress to sinus infections or pneumonia. The remainder of cases will resolve within a few days. When choosing a medication to treat cold symptoms, the best choice is always a single-medication product. This avoids giving unnecessary medications that may cause adverse effects in small children. After choosing a product, parents should give a dose that is appropriate for the child?s age and weight.

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