This page provides general advice about dealing with colds and the flu, including dosage recommendations for some commonly used OTC medicines. Please note that many cold/cough products have been recently taken off the market. Several studies have shown that these products are not effective in children under 6 years old and can have potentially serious side effects. Dosage guidelines are based on adult data and may be inaccurate for children. We also know that adult studies report common side effects including increase in blood pressure, increase in heart rate and restlessness with use of decongestants. For more information on colds, view this video from the American Academy of Pediatrics.
Our favorite cold/cough preparations are listed below. They are no longer recommended for children under four years of age. If you have found something useful for your child in the past, please do not hesitate to call our office for additional information. If you choose to treat a child over the age of four years, please remember they have not been proven to be more effective than humidifying the environment, avoiding airway irritants, and simply waiting it out. In general, upper respiratory infections/colds last 10-14 days from onset of symptoms until completely resolved. As a parent you must weigh the potential benefits and risks, and use these medications only when your child is experiencing significant enough symptoms to warrant TEMPORARY relief.
Mechanical alternatives such as suctioning the nose and throat with a bulb suction syringe, loosening mucus with saline solution (Ocean nasal spray, NaSal nose drops, etc.), and using a cool mist humidifier/vaporizer will help children breathe more easily while congested. Rest is important. Keep your child home from school or daycare until they are fever free for at least 24 hours. The American Academy of Pediatrics offers the following additional suggestions:
In general, it is best to give medicines only for the specific symptoms that a child is experiencing. Remember these products treat symptoms only. They will not make your child’s cold resolve faster, but they may help to make him/her more comfortable in the meantime. Do not use a multi-symptom product with a combination of acetaminophen and cold/cough products, because combo products often result in inadequate doses of acetaminophen. Please refer to the Tylenol/Motrin dosage chart for those doses. To ensure the correct dose, make sure you have a working thermometer at home (with fresh batteries).
During the cold/flu season your child may experience back-to-back colds/illnesses. Choose your medicines wisely. You can help your child through an illness by encouraging plenty of fluids and rest; avoiding airway irritants like cigarette smoke, scented candles, fireplaces and potpourri; and by providing extra TLC. Good hand-washing will help keep your child from picking up viruses which can live on surfaces for an extended period of time. You can help prevent the spread of germs in your own home by cleaning commonly handled surfaces such as doorknobs, light switches, and the remote control, with Lysol or another antiseptic cleanser.
Remember, antibiotics will NOT treat a cold or flu. These illnesses are caused by viruses. The more your child uses antibiotics, the more likely he/she is to get sick with an antibiotic-resistant infection in the future. Please feel free to discuss when antibiotics are warranted for an infection with our staff.
Benadryl (Diphenhydramine) comes as 12.5 mg/tsp or 12.5 mg chewable tabs, and as 12.5 OR 25 mg tabs/capsules. This is strictly an antihistamine. It can be used for allergies, to dry up a runny nose, or for itching and hives. Benadryl usually makes children sleepy, but in about 5% of patients causes a “paradoxical” reaction and makes them hyper. (Don’t try it for the first time when you are boarding an airplane with a toddler, in case they happen to be one of those 5%.) Benadryl should be given every 6 hours as needed. Since the medicine may make your child sleepy, some people try to use a slightly lower dose during the day, with the full dose given at night. Before using Benadryl in a child under 2 years of age, please call the office.
One of our favorite cold products is Grape Dimetapp Cold and Allergy. This is a combination antihistamine and decongestant that tastes good and generally does not make children “hyper” like the decongestant Sudafed often does.
In general, coughing is a protective mechanism that clears mucus from the lower part of the respiratory tract, and ordinarily there is no reason to suppress it. You may consider an occasional dose of a cough suppressant (generally something with dextromethorphan) for a child who has not been able to sleep/rest for an extended period of time. In our experience, cough suppressants are marginally effective in some (but not all) children.
Delsym is a dextromethorphan/cough suppressant which is supposed to last for 12 hours and can be dosed according to the following chart:
Guaifenesin is a mucus thinner and expectorant, which can be very helpful in loosening mucus and helping children "expectorate" or cough their mucous clear from their lower respiratory tract. This can be found in a liquid form in Mucinex Liquid or Mucinex "mini-melt" form or tablets. Please read dosages carefully as there are different strengths in these preparations. "Mini-melts" are meant to be dissolved on the tongue similar to the candy "Pixie Stix"; they are NOT meant to be chewed.
Mucinex Extended Release tablets (for use in children 12 and older) also comes in a formulation with seduoephedrine (for congestion) called Mucinex D that is stocked behind the pharmacy counter. Click here for more information on Mucinex.