Posted tagged ‘cold’

A cold, the flu, or sinusitis? Part 3: Myths

October 15, 2015

The Pediatric Insider

© 2015 Roy Benaroch, MD

You might not like to hear it, but the truth is….


Nothing really works well to treat these things

Colds, flus, and sinusitis all share some things in common—and the most important one is that just about all of us get these, and they make us miserable, and we want them to go away. Billions are spent on all sorts of things to treat these conditions, both from pharmaceutical companies and from companies that make supplements and other alternative-health nostrums. We’ll try just about anything. But if clinical studies reliably show that just about nothing really helps, why do we keep buying them?

I think the most important factor is simple human nature, and the way that symptoms change. If you have a cold, the symptoms get better and worse throughout the day—so if you take medicine or supplement XX when you feel really bad, the natural ups and downs average out, and you’ll feel better. But: you would have felt better anyway! Still, human nature, you took the magic beans (that you paid for), then you felt better, so there must be a connection, right?

That happens at the end of an illness, too. Let’s say you’ve had a cold for 6 days, and you go to the local get-me-some-drugs at the QuickieClinic. You get some antibiotics, and a few days later you start to feel better. Boom, QED, there’s all the proof you need. (BTW, docs are pretty much just as bad about giving out unnecessary antibiotics, too.) But: you were going to get better anyway.

Think about this, it’s really important: many symptoms occur like a mountain, with an up and a down. If you try therapy at the top, when you’re feeling bad, you will feel better. But that doesn’t mean that the therapy was why the mountain went downhill.


Flu shots work

The effectiveness of flu vaccines varies from year to year, but typically runs ~ 50-75% — that’s pretty good, really, for a health intervention (it’s much better than, say, the effectiveness of taking a cholesterol-lowering drug to prevent a heart attack. And some people take those every day for years.) It does mean, though, that in a family with say four people who’ve gotten flu vaccine, one child may not be well protected. That’s why it’s important for the whole family to get it.

Also: flu vaccines only prevent the flu. They don’t prevent colds. And they take 3 weeks or so to “kick in” – you don’t get instant protection.


Flu shots cannot cause the flu

MythsNo. They can’t, and they don’t. They can sometimes cause a little fever or achiness, but that is not the flu—and anyone who’s actually had the flu will tell you that these mild symptoms after a flu vaccine are pretty much nothing. Sometimes, right after a flu vaccine, someone does get the flu—that’s because we’re giving flu vaccines during flu season, and if you don’t get it in advance it can’t protect you. The vaccines take about 3 weeks to work. If you catch influenza right after getting the flu vaccine that’s called “bad luck” or “bad planning”, not “bad vaccine.”


Green snot means sinusitis

No, green snot means it’s been sitting around up your nose (you’ll often notice this overnight), and your white cells are busy fighting off the viral infection. Good for your white cells. Go blow your nose, and stop looking at the color—it doesn’t matter what shade it is.


Flu tests are needed to diagnose flu

Commercially available flu tests aren’t very good—they give a lot of false negatives (a negative test even in the setting of flu), and some false positives (a positive test in a person without flu.) Many health care facilities don’t even use them. A flu test can be helpful, sometimes, if I’m on the fence about a diagnosis, but they’re really just not very reliable to help make decisions about treatment.


Cold weather causes colds

Colds are caused by viruses, one of many from families called “rhinovirus” and “coronavirus” and others. They’re not caused by cold weather. BUT there is a germ of truth here: cold air in the nose can make it more likely that these viruses can be transmitted. Grandma may have been right!


I’m sure there are other myths, feel free to add your own in the comments!


The whole series:

A cold, the flu, or sinusitis? Part 1: Symptoms and Diagnosis

A cold, the flu, or sinusitis? Part 2: Treatment

A cold, the flu, or sinusitis? Part 3: Myths

A cold, the flu, or sinusitis? Part 2: Treatment  

October 12, 2015

The Pediatric Insider

© 2015 Roy Benaroch, MD

The previous post was about the symptoms of colds, the flu, and sinus infections—they’re not the same. This time, we’ll cover their treatment. And, surprise, it turns out that treating all of these is pretty much the same.

Style: "Neutral"

The most important part of treatment is rest and comfort. Get more sleep, and stay out of school or work until feeling better. That helps you and your children recover, and hopefully prevents the spread of illness. Drink more fluids, and have some soup.

To treat aches and pains, use acetaminophen or ibuprofen. It’s better to use these around-the-clock for a few days rather than just when symptoms become bad—these medicines are better at preventing pain and fever than treating pain and fever.

Treating nasal congestion is all about drainage. Use a humidifier and/or nasal saline spray. If your child is old enough, sometimes OTC decongestants given orally or as a nasal spray can help some, but they’re certainly not miracle drugs.

Coughs are annoying, but they’re there for a purpose: to get mucus up and out. If a cough is bothering your child, one of the best treatments is ordinary honey (for age 12 months and up.) Older children can sometimes benefit from OTC cough suppressants, but, again, they don’t work great. If your child has asthma, it’s probably a good idea to start up rescue medications during a cough.

There are a few more-specific treatments, depending on the diagnosis. If it’s influenza, a specific anti-viral medication (usually Tamiflu) can help some if started within the first 24-48 hours of symptoms. But the benefits of this medicine are modest at best. Tamiflu does not prevent serious complications, and only reduces symptoms by a little bit. Most people with influenza won’t notice any huge improvement with Tamiflu.

Sinusitis is typically treated with antibiotics, though even then the benefits of antibiotics are often over-stated. Studies looking at populations of both children and adults, comparing active antibiotics versus placebos, have shown really limited benefits to using antibiotics to treat sinusitis, at least ordinary, uncomplicated cases. And, of course, these same studies show that people taking antibiotics are much more likely to experience side effects and adverse reactions than those taking placebos.

The good news is that whatever you do, you’re going to get better. Whether it’s a cold, the flu, or sinusitis, symptoms will get better with or without treatment—though you’re going to be feeling sick for a while. If that’s the case, why does it seem like Tamiflu, antibiotics, OTC supplements, and all sorts of other things “work”? Next up, Part 3: Myths.


The whole series:

A cold, the flu, or sinusitis? Part 1: Symptoms and Diagnosis

A cold, the flu, or sinusitis? Part 2: Treatment

A cold, the flu, or sinusitis? Part 3: Myths

A cold, the flu, or sinusitis? Part 1: Symptoms and Diagnosis

October 8, 2015

The Pediatric Insider

© 2015 Roy Benaroch, MD


We’re heading back into colder weather again, and along with the change in the leaves comes more people with miserable, congested noses. Today’s post is all about telling the difference. Next time, I’ll tell you how to treat them.


The common cold

Captain ColdAlso called an “acute upper respiratory infection”, a “cold” is far and away the most common cause of congestion and cough. It usually starts with a vague ill feeling, followed by a sore throat and then a congested or drippy nose. Sometimes, there’s a fever at the start of the illness (that’s more common in babies and younger children.) A few days later, a cough begins. On average, the symptoms of a cold last about 10 days, though often the cough lingers for 2 or 3 weeks.

Notice: the symptoms grow or develop over several days, and the fever is really only at the beginning. By day 7-10 things are starting to improve.



“The flu” is a specific viral infection, and it’s not just a bad cold. Symptoms including fever, sore throat, body aches, nasal congestion or drip, and cough all pretty much start all at the same time, or within a few hours. Sometimes there are also gastrointestinal symptoms like abdominal pain or vomiting. Fever and aches are usually the worst symptoms – you feel, pretty much, like you’ve been hit by a truck. The worst symptoms last five days, but the congestion and cough often linger for another week or so.

Notice: the symptoms are sudden and severe.



Most common colds, of course, go away on their own, with or without any kind of treatment. But rarely a common cold can turn into a sinus infection. That occurs when the persistent mucus becomes infected with bacteria, leading to worsening symptoms 7-10 days into an ordinary cold, or persistent symptoms 2 weeks after a cold begins. Very rarely, sinusitis can start suddenly and severely, but much more typically there is first a cold that turns into a sinus infection.

Notice: a sinus infection is like a cold, but the symptoms worsen after 7-10 days. A congested nose for less than 7-10 days is unlikely to be a sinus infection, even if it feels really stuffy.


Next up: treating colds, the flu, and sinus infections.

The whole series:

A cold, the flu, or sinusitis? Part 1: Symptoms and Diagnosis

A cold, the flu, or sinusitis? Part 2: Treatment

A cold, the flu, or sinusitis? Part 3: Myths


Flu, a cold, or something else

March 11, 2009

Mindy wants to know what the difference is between a cold and the flu: “Someone told me he knows he has the flu when he’s sick in the winter if he has a fever.  No fever, it’s just a cold.  So, if my son has a cold in the winter and his fever is 101 or so, does that mean he has the flu?  (or is more likely to have the flu)?  We’ve all had our shots so symptoms will be light this year anyway if it is flu so it’s hard to tell from symptoms.”

The symptoms of influenza really are quite different from a common cold.

The flu starts suddenly, with severe symptoms arising all at once, or within a few hours. A typical fever is 103 or higher (highest I’ve seen is 106.1), and it’s accompanied by chills and shaking. There are body aches, head aches, and belly aches, and sometimes some nausea and vomiting. There may be a cough or sore throat, but these usually aren’t severe. An episode of flu lasts about five days. People who are vaccinated are much less likely to get the flu, and if they do the illness is usually more mild, with lower fevers and a shorter illness.

A cold usually creeps up on you, rather than starting all at once. It begins with a day or so of a vague feeling of unwell, just a feeling that you’re coming down with something. Then a sore throat will begin, and last a few days. During this first few days there may be a fever, though usually not over 102 (children tend to run higher fevers than teens or adults.) After a few days of sore throat the throat gets better while the nose gets more congested, and after the nose is stuffy a cough often begins that can linger for a few weeks.

Just to throw in another common wintertime ailment: strep throat is another sudden-onset illness. The main symptoms are sore throat, which can be very uncomfortable, plus a fever, headache, and belly ache. Runny nose and cough are absent, and flu-like body aches don’t occur.

So: cold symptoms + a fever of 101 is almost certainly just a cold—which can still be unpleasant, but isn’t the flu. Another way of looking at this: people who’ve had the flu, the real flu, will tell you that it’s nothing like a cold. If you’re not sure if it’s the flu or a cold, you’ve probably got a cold. The best advice: wash your hands, get some sleep, and have some nice chicken soup.

Cold medicines, weasels, and a flaming piano

October 17, 2008

Captain Joe visited the site, and posted: “What’s Dr. Roy’s take on the recent announcement by the FDA and drug companies that children under 4 should not be given over-the-counter cough and cold remedies?”

Joe, what’s happened was a sneaky end-around by a very clever industry. You’ve got to give them credit for coming up with a truly weasely way of handling what would have soon become a sales nightmare for them. And they did it in a way that will hamstring the FDA and keep the money rolling in.

First, some background: in an older post I reviewed the best current evidence: so called “cold medicines” do not work. These include “cough suppressants”, “expectorants”, “decongestants”, and “antihistamines” used to treat the symptoms of the common cold. Almost all of the well designed studies looking at these products have shown that they don’t work in children; the few studies that have shown effectiveness were done decades ago in adults, and have serious design flaws.

The only reason we think these products work is because we’ve been hoodwinked by their manufacturers. Years of pervasive advertising have reinforced the image of a caring mommy offering a sniffly child Dimetussiminic, with dad hovering, concerned, nearby. Doctors have contributed to this, too, by prescribing and suggesting prescription and OTC meds that most of us know are just expensive placebos.

What changed a few years ago wasn’t new science showing the meds don’t work—we already knew that—it was a series of reports of serious and sometimes deadly side effects. Now, we couldn’t just look at these products as benign placebos. Genuine side effects can happen, and can kill.

Almost all of these side effects occurred with overdoses in children less than two. Many of the overdoses occurred because so many of these products actually contain multiple ingredients that are hard to figure out from the labels. So a dad might give three “cold medicines”, not realizing that they all contain the same ingredient. A triple dose lands Junior in the Emergency Room, or worse.

A few years ago, the FDA starting looking critically at the data, and in 2007 an advisory committee concluded that because there was zero evidence that these medicines worked, and considerable evidence of their potential harm. The FDA advisory committee recommended banning the sale of cold medicines to children less than SIX years of age.

The FDA didn’t take that step. In conjunction with industry leaders, an interim decision was made to stop marketing and selling cold medicines to children under two, and to allow a time period for further input before taking further steps. The FDA scheduled public hearings, the most recent of which was October 2, 2008, to consider input regarding the best way to proceed—that is, whether to take the advisory committee’s suggestion to extend the ban up to age SIX.

Over a year has passed since the advisory committee’s recommendation. Knowing that the FDA would eventually follow its advisory committee, the pharmaceutical industry realized that having at least part of a money-making pie was better than losing the whole thing. Rather than wait for the FDA’s decision, they voluntarily announced that they will change their labels to say that the products shouldn’t be used under age FOUR. Of course, until the new labels are made, existing products won’t be pulled.

Now, what would you do if you were in the FDA’s shoes? They had to announce that they support this industry decision—doing less would make them seem less concerned about children than the drug sellers. But now, can they really come back in a few months and raise the age to six? If they do, they’ll look ridiculous. It will seem to most people that the FDA has no idea what they’re doing: after all, didn’t “they” just announce you shouldn’t take these meds less than four? And now it’s less than six?


To summarize:

  • Serious reactions can occur if “cold medicines” are used in children, especially under age 2.
  • For older kids, they’re pretty harmless as long as the correct doses are used.
  • They don’t work.
  • The companies that sell them are apparently staffed by clever weasels.

Related posts of mine:

Treating cough less than two

A cold lasts longer than you think

An unrelated video of a rich British guy throwing a flaming piano with a giant catapult. Go on, you know you want to see it.

Taking a newborn outside

May 23, 2008

A post from Steve: “I have a newborn baby girl and I was wondering how long after birth does she need to stay in the house. I have heard everything from 1 month to three. If we do take her out what places should we avoid?”

If your daughter is healthy– born at or near term, with no problems—she can go outside any time the weather is nice.


Treating cough less than two

May 6, 2008

Here’s a question from Holly: “What can you recommend, if anything, for nighttime coughing? Adults can just knock back some cough medicine, but there doesn’t seem to be any equivalent solution for young children (under 2). It’s sad when the coughing is bad enough that they wake themselves up and then start crying because they really just want to sleep. I’m not asking about chronic coughing, just the kind related to a regular cold.”

This question is also addressed in this post from last month. Cough and cold medicines really don’t work very well at any age, but for children less than two there are none that are approved for use in the United States. Cough medicines that have been prescribed in the past are ineffective, and even worse, they’re potentially dangerous.


A cold lasts longer than you think

April 12, 2008

Here’s a simple question: how long should symptoms of a common cold last? Three days? How about five? Maybe a week?

A study published in January, 2008 sought to answer that question. School-age children were followed for several months, and kept records of the onset and duration of common cold symptoms like fever, congestion, cough, sneezing, and runny nose. During the study period, 81 colds occurred. The investigators also collected mucus from the kids during their colds to test it for viruses and bacteria.

Cough and cold medicines don’t work

April 5, 2008

Health authorities are reporting that commonly-used cough and cold medications are not safe and are not effective. Since colds are so common and affect all of our children at least a few times a year, parents ask me every day about the new guidelines, and about the safest ways to help their children feel better.

First, some details. The medications that are commonly suggested to relieve the symptoms of the common cold fall into just a few groups. Within each group, the available choices are all essentially the same. Often, medications from several groups are combined to make what is optimistically sold as a “multisymptom cold reliever.”

Decongestants include products with the active ingredients pseudoephedrine and phenylephrine. They are supposed to work by shrinking the lining of the nose and decreasing nasal mucus secretions. Decongestants also raise a child’s heart rate and blood pressure, and may cause hyperactivity, agitation, and sleeplessness. Good studies have never shown decongestants to be effective in children, and even in adults their clinical effect is probably very small.

Cough suppressants are another group of medications purchased to help with the symptoms of the common cold. The most widely used over-the-counter product, dextromethorphan, has become a drug of abuse among young adults. Good studies have never shown that dextromethorphan is effective in stopping a cough; in fact, a recent study showed that in children, honey may be just as good or better than this medication. There are some prescription-strength cough suppressants as well. These are usually narcotics with strong sedating effects and some potential for abuse and addiction. Even these potent drugs, with all of their side effects, are very effective at actually helping a child who has a cough.

Antihistamines can certainly help with symptoms of nasal allergy, and are often used for colds as well. If you’re not sure if your child has allergies or a cold, a safe dose of an antihistamine may be worth trying. But it won’t help if your child’s runny nose is caused by a cold. Some families may find that the sedating effect of antihistamines can allow better sleep, at least for the parents. Newer, non-sedating antihistamines like Claritin and Zyrtec are expensive and offer no benefit whatsoever to children with the common cold.

Expectorant medications include those with the active ingredient “guaifenesin”, sold under the brand name Robitussin. These are supposed to thin secretions and help clear mucus. Unfortunately, no studies have ever shown that these medications actually work; and the liquid forms taste horrible. Among the medications reviewed so far, expectorants are the least likely to cause any side effects. Even though they’re unlikely to be effective, at least they’re safe enough to be worth trying in some cases.

The medicines reviewed so far—decongestants, cough suppressants, antihistamines, and expectorants—are collectively called “cold medicines.” They’re combined in all sorts of ways in products marketed to children, including common brands like Dimetapp, Triaminic, Pediacare, and many others. These are the medications that have generated some increased controversy over the last years because of questions of their safety and effectiveness, and the way they’re marketed to children.

In 2004 and 2005, about 1500 children less than two years of age were treated for adverse events triggered by cold medications. While many of these reactions were mild, more serious reactions including seizures, stroke, and death have occurred. Though industry representatives feel confident that these more severe reactions are not possible if the medications are dosed correctly, safe doses of these medications are not well-established or agreed upon by pharmacists and pediatricians.

In August, 2007 an FDA advisory panel recommended that cold medications not be used under age six, citing both a lack of evidence that they work and concerns about their safety under age two. Shortly after that, several large manufacturers of these products voluntarily recalled cold medications that were packaged for use in babies and toddlers. In January, 2008, the FDA formally announced that they advised against the use of these products under age two, and that later this year they will make recommendations for older children.

So what can a parent do to help the miserable symptoms of the common cold in a child? First, several non-medicine approaches can really help. Frequent use of non-medicated saltwater (also called saline) drops can help clear mucus from the nose and is safe at any age. You can buy these drops over-the-counter, or mix them up inexpensively yourself. Other methods to keep nasal secretions runny and loose will also help. Encourage a child to drink more fluids, use a humidifier, and sit together in a steamy bathroom. Honey can be used safely in children past their first birthday to help settle a child’s cough. (Honey should never be given to infants less than one year of age.) Though these are many other alternative or “natural” medicines that are marketed for children with cold symptoms, many of these have unknown safety and effectiveness. If you’re interested, we can cover more details about these products in a future post.

Medicines that reduce fever and relieve aches and pains are safe and effective, and can help with some of the symptoms of a cold. These include acetaminophen (found in Tylenol, and safe at any age), and ibuprofen (found in Motrin and Advil, and safe for use in babies six months and up.) Confirm the correct dose for these based on your child’s weight with your pediatrician.

In summary, many of the medications commonly sold to reduce symptoms of the common cold just don’t work, and they can be unsafe especially if used under age two. To help your child feel better, rely on simple home remedies that thin secretions and help clear out stuffy noses. If you do want to use a medication, follow the dosing guidelines of your pediatrician or pharmacist closely, and always keep medicine bottles away from children. As miserable as it can be, a cold is going to get better all on its own. It’s not worth it to use approaches that might lead to far more serious consequences than a cold itself.

© 2008 Roy Benaroch, MD from