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Drug-Store Remedies May Send Kids to Hospital

Over-the-counter drugs won't counter a kid's cold, research finds

MONDAY, Sept. 17, 2001 (HealthDayNews) -- Don't automatically reach for over-the-counter drugs when your child has a cough or stuffy nose. The drugs not only don't help, they can be deadly, says an article in the latest issue of Pediatrics.

"While in general they're safe, they don't have demonstrated benefits, [and] they can be dangerous, and they're costly," says author Dr. Veronica Gunn, senior fellow and chief resident in the Department of Pediatrics at Johns Hopkins Children's Center. "In weighing the pros and cons, I encourage parents to try and wait it out with love and tender care and some fever reducers."

The article highlights three cases in which doctors at the center admitted young children because they'd taken over-the-counter cold and cough preparations when they shouldn't have. One patient, a 9-month-old boy, died. Gunn helped care for two of the three children.

In one case, the parents of a toddler admitted for a rapid heartbeat repeatedly insisted that the only drug they had given their child was children's Tylenol for his fever.

The medication was "Children's Tylenol: Cold," and it contained not only acetaminophen, but several other medications, including pseudoephedrine. One possible side effect of pseudoephedrine is rapid heartbeat.

In another case, a 3-year-old boy had been given an unknown amount of Dimetapp, which contains an ingredient the Food and Drug Administration (FDA) is considering banning. He was treated for lethargy, vomiting and other symptoms before being discharged.

The baby who died had been given an array of drugs in numerous doses, an autopsy found.

While discouraging parents from giving their young children the preparations, Gunn says she understands their desire to intervene. The average child has six to 10 colds a year, she says. For those who can't accept that a cold or upper respiratory infection probably will last a week to 10 days and that they should just wait it out, Gunn says she tries to negotiate a time limit for using over-the-counter medications.

"I don't find it unreasonable at all for parents to look toward these interventions to provide some alleviation to the symptoms. I tell them to give it [for] a couple of days, and if they don't see any improvement, then stop it," she says.

Dr. Denise Salerno, an associate professor of pediatrics at Temple University Children's Medical Center, says she routinely discourages parents from using over-the-counter preparations.

"We don't really recommend them, especially for children less than 2," she says. "You'll have a preparation that has a cough suppressant and an expectorant. One is supposed to quiet a cough, and the other is supposed to loosen up phlegm to make it easier to cough it up. Why would you put them in the same medication is beyond me."

Salerno also takes the time to explains to parents what to expect from a cold.

"It's going to last five to 10 days," she says. "It's normal for congestion to go from clear to yellow to clear, and coughing is good. You want them to cough and get rid of those irritants. The only time we recommend a cold or cough preparation is at night for coughing so they can rest."

The American Academy of Pediatrics (AAP) issued a policy statement in 1997 about cough and cold preparations containing codeine or dextromethorphan, cough suppressants that work well for adults but don't work for children. It said the two ingredients can have adverse effects, and children can overdose on them fairly easily. The AAP recommended that physicians "clearly educate parents about the known risks and lack of benefits of these medications."

Last fall, the FDA also recommended that the decongestant phenylpropanolamine (PPA) be removed from all cold and cough preparations because of a risk for causing a bleeding stroke.

What To Do

Faced with an infant or toddler with a hacking cough and a crusty, green nose, parents still need some way of dealing with the symptoms.

Warm -- not hot -- soothing drinks, like decaffeinated tea, or clear soup can help clear stuffy noses, as can vapor rubs on the chest. But Gunn says don't put the rubbing creams around a child's nose and mouth. Humidifiers keep the air moist and will keep sinus secretions from drying out, making them easier to wipe away.

For babies, Salerno recommends saline drops "to loosen up stuff to suction out with a bulb. "Saline up the nose doesn't have any side effect," she says.

Check the AAP's policy statement on the use of over-the-counter cold and cough preparations. But have a medical dictionary handy; the statement is written for doctors.

Visit the FDA to read its public health advisory on phenylpropanolamine (PPA).

And KidsDirect can tell you what to expect from a cold.

SOURCES: Interviews with Veronica Gunn, M.D., senior fellow and chief resident, Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, Md.; Denise A. Salerno, M.D., FAAP, assistant professor of pediatrics, Temple University Children's Medical Center, Philadelphia, Pa.; September 2001 Pediatrics
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