When children catch a cold, parents feel it too. Little noses mutate in freakish ways—at once stuffy and runny with green goo. Fevers spike. Coughs become croaks. And no one sleeps. This is when over-the-counter medicine is often thought to be useful, especially those advertising cough and cold relief. Except that remedy may, in fact, do more harm than good.
A new study, published this week in the Canadian Journal of Public Health, reveals that “a high proportion” of children receive over-the-counter cough and cold medication (CCM)—despite labels warning against their use in anyone under six years of age. The research shows there has only been a slight decrease in the misuse of CCM in young children—down to 18 per cent in 2011 from 22 per cent in 2009, when Health Canada first required manufacturers to implement the warning label.
Put another way: There is a disconnect between approved practice and real life. “It’s important that we have a dialogue around cough and cold medications for children. Parents are seeking it. Public health institutions advise against it. So there’s a problem that needs to be sorted out,” says Dr. Jonathon Maguire, a Toronto paediatrician and co-author of the study.
The risks, albeit rare, are too high to ignore, especially since youngsters may struggle to vocalize or even identify side effects. “For a long time there [were] sporadic case reports of complications,” says Maguire of the years before health authorities in Canada and the United States issued advisories. “It was known that about five per cent of emergency department visits for medication problems were related to CCM. And an expert panel identified over 100 cases where children had died.”
In October 2009, Health Canada required the warning label on paediatric CCM containing antihistamines, antitussives, expectorants and decongestants. “If it says ‘cough and cold’ [on the packaging] then it has other ingredients in it that children under six are not supposed to get,” says Maguire. And there’s another reason to reconsider using CCM: “There’s quite a bit of evidence that really questions their effectiveness in children.”
Of course, when kids feel sick, most parents are compelled to do something. Maguire says alternating between age-appropriate acetaminophen and ibuprofen to treat a fever is acceptable. “Let’s face it, when your child has a cold it’s tough, and a lot of families really struggle with that added stress,” says Maguire.
“The reality is that for the vast majority of children, these conditions are self-limited and we just have to be patient.”
All told, the warning label has only had a “small” and “minor” effect on consumers of children’s CCM, concluded the researchers from the University of Toronto and St. Michael’s Hospital. “Stronger measures may be needed to curtail their use.” Among them: a more pronounced warning label, or placing these medications behind the pharmacy counter. “People really do want to do what’s best for their children,” says Maguire, “and I think they’re unknowingly doing things that may not be in their best interest.”