Posted tagged ‘uri’

Preventing colds: Kids show us how it’s done

August 28, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

Want to get fewer colds, skip the flu, and avoid using the toilet face-first? One of the most effective ways to prevent infectious diseases is to stay away from mucus. Other people’s mucus, that is—the infectious toxic goo that sick people can’t seem to avoid spreading all over the place.

Two recent studies illustrate that it really is possible to stay healthier thru goo avoidance. But the kids seem to be better at it than we are.

I wrote earlier about the first study, where adults were observed during, let’s say, events of mucus production. Surprise! The vast majority of adults did nothing to limit the spread of their sneezes, and even helped further spread their germs by wiping their snot-covered hands on doorknobs and other surfaces. Look around you. If you see adults, they’re trying to make you sick.

Compare that to a more recent study of children, summarized here. Danish schoolchildren underwent special training in hand washing, and were required to follow good hand hygiene while in school. Over the following months, compared with kids in other schools without the special training, the children in the handwashing groups had about 25% fewer illnesses and missed days of school. Even better—the following year, when the special training and requirements were dropped, those same children still continued to wash their hands, and continued to have a reduced rate of illnesses. The kids learned, and it worked, and it stuck! Take a lesson from these kids: good hand hygiene is a habit that we can learn, and a habit that really can keep us healthier.

If it makes you sick, it probably likes mucus. Try to keep your mucus to yourself, especially when you’re ill. When you’re sick, sneeze into your elbow and wash your hands! If you don’t want to become ill, wash your hands before eating or especially before touching your own face. In fact, you might be able to prevent many infections by developing a new habit: don’t touch your eyes, your nose, or your mouth without first washing your own hands. The germs on your skin won’t make you ill until you rub them in your eyes or up your nose. With the kids back in school and winter approaching, now’s a good time to work on those anti-mucus, staying-healthy habits. Let’s all keep our snot and germs to ourselves.

Infections now, or infections later: Does day care keep children healthier in the long run?

March 6, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

Tracy has a good question: “My 4 year old is not in day care – he stays with Granny. I heard that once you get a cold, you never get that cold again, and I am worried he isn’t exposed to enough germs now to keep him healthy later. Should we be trying to infect him with more colds now that he has the luxury of staying in PJs all day instead of hitting him with all these new viruses when he does start school?”

For many viral infections, it’s true: you get it once, you won’t get it again. Think about chicken pox, measles, or hepatitis A—suffer through the infection, or get the vaccine, and you’re pretty much protected for life. Second infections or breakthrough disease after vaccination can happen, but it’s uncommon. This doesn’t hold true for bacterial infections like pneumonia, whooping cough, or ear infections, but for many viruses immunity can last the rest of your life.

But the common cold isn’t caused by one virus, or even one family of viruses. Common cold symptoms occur with hundreds of kinds of rhinoviruses, coronaviruses, and the recently-discovered metapneumovirus, to name just a few. Each cold may earn you immunity from one variety of one virus, but there are plenty more of them lurking out there.

What about the cumulative effect of the dozens or hundreds of viruses kids in day care? Do day-care kids earn lasting protection from enough viruses to keep them healthier once they’re in school? And does that mean that kids who spent more time in their PJs with Granny will get sicker once they start kindergarten?

A study published in December 2010 tried to figure that out. Researchers followed about 1300 families in Canada over eight years to record the frequency of infections in children through their years of day care and school. They looked at upper respiratory infections, ear infections, and “tummy bugs” that caused vomiting and diarrhea. Their conclusion was actually quite satisfying: children, whether or not they attended day care, suffered through approximately the same number of infections over the course of the study. But day-care kids got more of their infections when they were younger, especially when they first started in group care, while kids who didn’t attend day care got more infections later when they started school. The piper gets paid, either way: get your infections over with early, or get them later.

It’s reassuring to know that overall, neither group of children was really sicker than the other. Whether or not children attend group care when they’re young doesn’t seem to affect the total number of infections, but rather only the timing of their infections. Parents can choose whether their children will get more infections now or later, but the total number of infections is going to be about the same either way.

Zinc supplements for the common cold

February 18, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

The Cochrane Collaboration is a very well-respected international non-profit whose 28,000 volunteers review the best, solid evidence to help determine if medications or other health interventions really work. They are, in short, da bomb.

When Cochrane speaks, people listen.

Cochrane last week released a review of studies examining the effectiveness of zinc supplementation on preventing and treating the common cold. They found that there was good evidence that zinc taken early, during the first symptoms of a cold, can lessen the duration and severity of illness; furthermore, zinc taken daily during cold season can reduce the frequency of these annoying infections.

There were only 15 good quality studies to look at, involving a total of about 1400 patients. Because the studies varied in how much zinc was given, in what form, and how often, no conclusion could be drawn about the best dosing strategy. Nor could any conclusions be drawn about using zinc in children. Still, the evidence tantalizing, and more research is needed to pin down these details.

Zinc is fairly well-tolerated and safe. The most common side effects reported were an unpleasant taste and nausea. There is no particular reason to think zinc in reasonable doses would be unsafe in children or adults.

If you want to try zinc, there are drops, lozenges, and pills to choose from of varying strength and composition. Follow label directions for dosing. For these products to work to treat the cold, you have to start them quickly, and take them frequently throughout the day.

One other warning: the Cochrane review was looking at genuine, therapeutic doses of zinc. Many other zinc products are produced and marketed as “homeopathic”—meaning there isn’t any actual zinc in the bottle. Homeopathy is literally nothing. It’s a kind of witchcraft that relies on the nonexistent magical memory of water. Don’t waste your money on anything labeled “homeopathic.” If you want to try zinc, choose a genuine zinc product that measures the dose in milligrams, not in magic memories.

Humidifier versus dehumidifier smackdown!

December 5, 2010

The Pediatric Insider

© 2010 Roy Benaroch, MD

Shannon wrote in, “I just recently read in a magazine that a humid environment as opposed to a dry environment is more hostile to viruses. It sounds a little counter-intuitive to me, however, if it’s true would it be best to run my children’s humidifiers all winter long to stave off the flu and other viruses as this article recommended? I tend to run them more in the winter anyway because my kids tend to have more runny noses or their nasal passages are drier and bloodier. What are your thoughts?”

I’m not sure the viruses, themselves, would even care. Viruses are just little teeny packets of genetic material, with a small handful of protein. They’re not cells, so they won’t “dry out”, and I doubt that their survival would depend much on humidity.

I would guess, though, that a dry environment might make it easier for viruses to invade the nasal lining to make your children sick. Viruses can’t penetrate normal intact skin, and even moist surfaces like the lining of a mouth or nose does a pretty good job repelling these little monsters (the viruses, I mean, not the children.) But once the lining of a nose gets dried out and develops cracks and fissures, the viruses can grab hold and jump right in.

By preventing dry air with a humidifier, you’ll also keep whatever mucus is around nicely wet and runny—that’s good, because thin and runny mucus is less likely to plug up noses and sinuses and get infected with bacteria. Thick and sticky mucus just sits there, an inviting bacterial playground. Thin and runny mucus drains, carrying infection away.

If you do run a humidifier all winter, you’ve got to keep it clean. That warm, moist environment can also become a playground for mold. Once a week, take the humidifier apart, wipe it down with diluted bleach (1 capful per gallon) and let the pieces dry before re-assembling.

What kind of humidifier is best? The ultrasonic ones are easiest to clean, so those get my vote. The kind with the big fabric wicks are just about impossible to clean well, and the ones that use a heating coil could cause burns when Junior pulls it over onto her head.

More articles about mucus, which has apparently become a favorite topic at my blog. Momma would be proud:

Out, Damn’d Snot

Control your mucus

Too many colds

A cold lasts longer than you think

Cough and cold medicines don’t work, updated here

Great study, but wrong conclusion: The Vapo Rub fail

November 9, 2010

The Pediatric Insider

© 2010 Roy Benaroch, MD

A study due for publication in December, 2010 claims to show that Vick’s Vapo Rub can help your child fight through the common cold. Though it was funded by the manufacturer (Procter and Gamble), it’s a good study—but if you read it carefully, there are some big red flags that say “Beware!” I don’t agree with the author’s conclusions, and I don’t agree with headlines in the media extolling the virtues of Vick’s. The study was well-designed, but the authors themselves found a fatal flaw that renders their results meaningless.

The study design was solid, and cleverly tried to prevent parents from being able to skew the results. 138 kids from age 2-11 years with at least moderate coughs were recruited. Children with more-specific causes of cough, like asthma, were excluded; and the children were not allowed to take other kinds of medication that might suppress a cough. The group was divided into thirds: one group received no treatment at all, one group received plain petrolatum (similar to Vaseline), and one group received Vick’s Vapo Rub. The parents were given a glass jar in an opaque bag with their study drug (or an empty jar, if they were in the no treatment group), along with a second jar that contained Vapo Rub in all three groups. When the families began treatment, they were instructed to first rub Vapo Rub under their own noses—then rub the study medication on their child’s chest. By putting Vapo Rub on the parents, the hope was that parents would not be able to tell whether they had put plain petrolatum or Vapo Rub on their child’s chest.

The next day, parents filled out a questionnaire, recording how well, or how poorly, their child did. The kids who received Vapo Rub did the best, especially when their ability to sleep was judged. That’s what the mainstream and medical press are reporting. But sometimes it pays to read the study a little bit further.

Thought the authors tried to prevent the parents from knowing what treatment group they were in, 90% of the parents correctly “guessed” what their child had been treated with the night before. I don’t know if the parents were able to smell past the Vick’s on their own noses, or if they didn’t follow directions, or if the approximately 50% of children in the Vapo Rub group who developed skin irritation gave it away—but in any case, this was essentially an unblinded study. Almost all of the parents knew whether their child was treated with Vick’s or the placebo—and that could certainly account for the observed differences in how the children did.

It’s human nature. The placebo effect has been documented in almost every clinical study that’s been done. People who are given what they think is medicine expect to get better, or expect their kids to get better, and will honestly judge that they did get better. Even if the “medicine” is itself just a placebo. Our own expectations influence our perceptions. If study participants are aware of whether they’re taking placebo or the study drug, clinical studies of medications are worthless.

There are other reasons to think twice before using Vick’s Vapo Rub. It can be quite toxic—according to the discussion section of this new study, an 8 tsp dose can kill a child. Much smaller doses are probably safe, but have occasionally been linked to seizures (children with seizures were excluded from the study.) In children less than two, Vick’s can cause serious lung irritation and breathing troubles.

When deciding whether to try a treatment, parents and physicians ought to weight the risks and the benefits. This study, in which the participants were inadvertently unblinded, allows us to draw no conclusions about whether Vick’s actually works. We do know that there are genuine risks. I’d stay away from Vicks, especially in younger children, until there is better proof that it actually works.

If you do want to try Vick’s Vapo Rub, follow the directions carefully. Do not put any near your child’s mouth, and do not use it in children less than two. Keep it way out of the reach of children and pets.

Too many colds

April 18, 2010

The Pediatric Insider

© 2010 Roy Benaroch, MD

Claire wanted to know why her kids get sick so much. So many colds, so much snot. Is there any way to stop this?

Colds are called “upper respiratory infections” in doctor-talk. They’re caused by one of hundreds of viruses that invade the tissues of your nose, sinuses, and throat. Typically symptoms begin with a sore throat, move into a stuffy nose, and then cause a lingering cough as a good-bye present.

Normal kids get a lot of upper respiratory infections, about twelve per year for pre-schoolers and nine per year for kindergarteners. They tend to occur more frequently once school starts in the fall, and last all through the winter. So from September through March you can expect what will seem like at least one cold a month. Since ordinary colds last at least 10 days, for the winter it seems like many kids are sick more days than they’re well.

What about those kids who really do get more than their share of colds, or the kids whose colds linger for weeks and turn into sinus infections or other problems? Think about these kids in three groups:

  1. Otherwise completely healthy kids who just get a lot of colds. They get better on their own, but seem to get “frequent colds” one after another in a string of isolated episodes. There’s no history of other infections, unusual infections, or anything else about these children that seems unhealthy.  They’re often in day care or school, and sometimes get extra exposures to cold viruses from helpful siblings. This is the largest of the three groups.
  1. Kids who “keep a cold.” These children get many colds, but don’t get better on their own. The cold symptoms linger and last “forever.” Often their colds will turn into ear infections or sinus infections, and won’t get better until an antibiotic is prescribed. Other than the lingering colds, these kids are not otherwise unwell. They don’t get lots of infections other than these respiratory problems, they’re growing well, they’re doing fine. They just have persistent snotty noses.
  1. Kids who are genuinely unwell. By far, this is the smallest of the three groups. These are children who are often not growing well, and suffer from many other frequent infections including chronic diarrhea, thrush, and other unusual or chronic, hard-to-treat infections. Kids in this group should be aggressively evaluated for an immune deficiency, and should be seen by a specialist in pediatric immunology.

Kids in group 3 are rare, but characteristic, and it’s easy to tell that these children are different. It’s sometimes tricky to separate group 1 from group 2, especially if the group 1 kids get so many colds that one just immediately follows another. The best “test” to tell if your child is in group 1 or group 2 is for parents to keep a “snot calendar.” Group 1 children, the “frequent colds,” really should get completely better, at least briefly, in between individual cold episodes. Group 2 kids, the “keep a colds,” have symptoms that get better and worse, but are never completely free of cold symptoms.

“Frequent colds” versus “keep a cold” kids are different. Though they might both benefit from strategies to prevent colds in the first place (more about that later), the children who “keep a cold” very often develop complications of viral respiratory infections: bacterial sinusitis or ear infections. Snot that stays in one place for too long is very inviting to bacteria– like a sticky, inviting swimming pool– and eventually, kids who “keep a cold” are going to be infected with bacteria. To help avoid these secondary infections, families with “keep a cold” kids need to get very aggressive about clearing out mucus. Use a humidifier, long steamy showers, and saline nose drops. Anything that physically clears out mucus will make secondary infections less likely. The children will feel better, and will need fewer antibiotics. Families who get good at mucus control might even be able to avoid a trip to the ENT for sinus surgery or ear tubes.

“Keep a cold” kids tend to run in families, probably because their parents share their same small sinuses and ear anatomy that makes clearance of mucus difficult. Some of these kids might also have allergies that trigger very similar symptoms. If your child who keeps a cold has symptoms of allergy (itchy nose, itchy eyes, sneezing) or a strong family history of allergy, further testing or treatment of possible allergies might be worthwhile.

Whether your child is in the “frequent colds” of group 1 or the “keep a cold” of group two, strategies to avoid infections are a good idea. Many, many respiratory virus exposures occur in day care. Can you move your child out of group care, at least for the winter? Children can be taught not to rub or touch their own face, which prevents viruses on their hands from invading their usual ports of entry, the nose, eyes, and mouth. Avoid playing with toys in common areas like doctor waiting rooms, and stay out of little gym classes and fast food play areas. Get into the habit of washing hands frequently or using an alcohol-based hand sanitizer to prevent not only upper respiratory infections, but common “tummy bugs” as well.

There are plenty of herbal products and supplements that claim to protect your child from colds. They’re quackery. Save your money for something else.

Some vaccines can help prevent at least some respiratory infections, and even some complications. Influenza vaccines should be given to all children each winter. Very recently, the Prevnar (pneumococcal) vaccine was improved to include several more strains of this common bacterial cause of ear infections and sinus infections. These vaccines will not prevent all or even most of these infections, but they can make an important difference.

What about medicines to treat Junior when he has a cold? Though they’re marketed very heavily, they’re not very effective. Your best bets for symptom relief during a cold are acetaminophen or ibuprofen for aches, nasal saline washes for congestion, honey for cough (over age 12 months), throat drops for sore throat, and ice cream for the child and the parents. There. Doesn’t that feel better?

Out, damn’d snot

May 26, 2009

“Out, damn’d snot! out, I say!—One; two: why, then ’tis time to do’t.—Hell is murky.—Fie, my lord, fie, a soldier, and afeard? What need we fear who knows it, when none can call our pow’r to accompt?—Yet who would have thought the child to have had so much snot in him?”

Macbeth Act 5, scene 1, 26–40. Adapted.

One of the joys of being a pediatrician is that I can still make jokes about snot. I get all serious sometimes during the physical exam, asking a six year old to turn up their nose for a careful look. Then I make a concerned “Hmmmmm noise”—you know, create some comedic tension—then, a pause, followed by one of my best one-liners: “Ewww! Boogers!”

It cracks them up. Really.

Shannon asked me to write about whether the fancy-pants new high-tech nasal aspirators are any better than the old fashioned ones at de-snotting kids. The truth is, I have no idea. But there are plenty of other booger-tidbits I’d be happy to share—so join me for what promises to be the most revolting post of 2009, a journey of mucus and fun!

Snot is nasal mucus, made by specialized cells lining the nose, sinuses, and the entire respiratory tree. It’s mostly water, plus specialized proteins called mucins that help create its wonderfully sticky character. Mucus also contains disease-fighting antibodies and chemicals that can tear apart infectious particles. Not only does it help prevent and treat infections, but it also keeps the nasal linings happy and moist, and humidifies inhaled air. Its sticky surface traps pollens, infectious particles, and airborne pollutants, sort of like built-in fly paper. Under ordinary circumstances, a person makes—and swallows– about a quart of it a day.

The most common “chief complaint” for visits to a pediatric office is nasal congestion, most often caused by an upper respiratory infection, or “the common cold.” The snot, especially early on in the cold when it’s clear and watery, is loaded with infectious viral particles. That’s why colds are so common: they make your nose runny and irritated, so you rub it, then touch a doorknob, and then the virus can easily spread to the rest of the family and everyone else in the classroom. Towards the end of a cold, snot will get thick and dark and lovely yellow-green (especially the stuff in that first morning tissue.) By then, the mucus isn’t infectious anymore. Rather than being loaded with virus, it’s filled with dead and dying infection-fighting cells and sloughed debris from your nose. It’s a misconception (unfortunately perpetuated by many doctors, I know) that green snot at the end of a cold means that there’s some kind of infection that needs antibiotics. ‘Taint true, though if thick persistent all-day mucus lasts longer than 10-14 days at the end of a cold, you might have a sinus infection brewing. It’s the duration of symptoms that helps distinguish a cold from sinusitis, not the color of the boogers. And no, you don’t need to bring in a sample for your pediatrician to examine. Really. Thanks.

Excessive snot could be caused by other things. Allergies can make your nose run, though more commonly allergies cause swelling of the lining of the nose, causing a congested feeling without much actual extra mucus. When you cry or have irritated, teary eyes, the tears drain into your nose through little ducts, which makes your nose run too. And a three year old who shoves a lego up her nose is going to get one heck of a snotty discharge in a few days. About once a year I see a toddler with a “cold”—but a cold that oddly enough only leads to nasal discharge from one nostril. If your child has two nostrils, but only one of them is runny, take a look up there. You might just find a toy you thought was missing.

Too much snot causes a few problems. In the short-run, it might make it hard for your child to get comfortable, and can interfere with sleep. More importantly, nasal mucus that just sits there in the nasal cavity is a warm and inviting media for bacteria, and can eventually lead to secondary bacterial infections like ear infections and sinusitis. So both for symptom relief and for the prevention of these infections, it’s a good idea to at least try to get the boogers out of there.

What about cold medicines? The short answer: they don’t work. Some contain antihistamines that may make your child sleepy—that’s not a bad thing, as long as it’s safe—but none actually decrease mucus accumulation . Topical decongestants like Afrin do work, but are potentially addictive and shouldn’t routinely be used in children.

So a more creative approach is needed. Traditional, effective advice includes giving the child extra fluids, humidifying the air, and sitting in a steamy bathroom. These will all keep the mucus nice and runny rather than thick and sticky. You can also put a few drops of saline solution in the nostrils, or even better use a nasal saline irrigator to wash out the boogies. Loose, watery mucus can also be sucked out with a traditional bulb aspirator.

You say you want something fancy, something high-tech, something to casually whip out to the oooohs and aaaaahs of the envious playgroup crowd? This electronic marvel boasts twelve different tunes it can play to distract your honey while her nose is sucked out. (Got to be at least 12. Junior would certainly complain if the same tedious song were played during each episode of nose-sucking. I’m surprised there isn’t a built-in MP3 player.) Or the Nosefrida, manufactured in Sweden, which apparently lets you inflate your baby’s head much like a carnival balloon. I can’t believe I’m raising three kids without it!

I have no experience with these newer nose-suckers, so please, if you get one, post a review. Anyone who posts gets double points if you include a photo—of the kid, not the snot. I really can live without seeing that!

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.

Don’t touch those toys

January 27, 2009

When you visit the pediatrician, keep your children away from the toys in the waiting room. It’s better to bring your own toys than to expose your kids to things that might make them sicker.

A study presented in October, 2008 confirmed that toys and other surfaces in the common areas of pediatrician’s offices often harbor disease-causing viruses. Furthermore, the use of disinfecting wipes really doesn’t make much of a difference.

Almost all common cold germs are picked up from contaminated surfaces by hands. You can bet that the surfaces, chairs, and toys in a doctor’s waiting room are probably coated with an infectious sheen of microorganisms. Children innocently rubbing their eyes or noses are probably inoculating themselves with a stew of whatever germs were left by the last sick child in the waiting room. This study confirms that these germs can survive for up to 24 hours, and are difficult to eradicate from surfaces even with good thorough wiping.

Colds may seem like an unavoidable nuisance, but there are some effective ways that can help your family stay healthy. Avoid sick people, get a good night’s sleep, keep your hands clean, and bring your own toys to the pediatrician’s office.

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?

Clever.

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.