For a child’s cold, the best medicine is no medicine

Parents are often disappointed or even upset when I tell them there’s no medicine to help their coughing, sneezing, drippynosed children feel better. There’s nothing that works, I say, and medicines can have bad side effects. We don’t recommend any cough and cold medications for children younger than 6.

But after all, parents are intimately aware of just how miserable a cough and runny nose and congestion can make a small child feel.

And often there is something both comforting and familiar about those over-the-counter medicines. “They all took these medications themselves; there’s a comfort in knowing that,” said Dr. Ian Paul, a professor of pediatrics at Penn State College of Medicine.

In a new review in The BMJ, researchers considered evidence on whether a variety of over-thecounter cough and cold medicines are effective for treating runny nose, congestion and sneezing, as well as the question of whether they can do harm.

“Parents are always worried that something bad is happening and they have to do something,” said Dr. Mieke van Driel, a professor of general practice and head of the primary care clinical unit at the University of Queensland in Australia and lead author of the study. As a primary care physician herself, she said, she is well aware of the urgency that parents feel to find something that will relieve their children’s distress.

“Unfortunately, our research shows there’s very little evidence,” she said, and especially in children. “We were actually quite amazed by how little there was — hardly anything to be enthusiastic about.”

In addition, Van Driel said, parents need to understand that there are clear risks in using them in young children. The Food and Drug Administration originally recommended against any over-the-counter cough and cold preparations in children younger than 2; the American Academy of Pediatrics has extended the recommendation to all children up to 6. And after manufacturers voluntarily withdrew products marketed for infants and changed labels to recommend against use in young children, researchers found a drop in children coming to emergency rooms for problems with these medicines, which in past studies ranged from hallucinations to cardiac arrhythmias to depressed level of consciousness.

When it comes to the sniffles or cough associated with the common cold, “these symptoms are self-limited,” said Dr. Shonna Yin, an associate professor of pediatrics and population health at the New York University School of Medicine. Parents can comfort their children without giving medications, she said, offering plenty of fluids to keep children well hydrated, and honey for a cough in children over a year old (no honey for babies under a year because of the risk of botulism). Other measures may include ibuprofen or acetaminophen for fever and saline nose drops for congestion.

“Our 2007 study was the first to show that honey was more effective than dextromethorphan” — a common cough suppressant — “or no treatment,” Paul said.

Since then, other studies have shown that honey does relieve cough, and the accompanying sleep disturbance.

“The bottom line,” Paul said, “is that for all of the over-thecounter cough and cold medications, there is limited to no evidence of efficacy for any cold symptoms, particularly in those under 6 years.”