Making Sense of OTC Drug Use in Kids

Get answers to questions about OTC drug safety for children.

From the WebMD Archives

It seems every time you on turn on the news or read a newspaper there is something new on how, when, or even if you can use over-the-counter (OTC) medications to treat your children’s sniffles, aches and pains, and fever.

What are concerned parents supposed to do, especially when their infant or toddler is up all night with a terrible cough or cold and flu season looms? WebMD spoke to Norman Tomaka and Elizabeth Shepard, MD, to find out. Tomaka is a certified consultant pharmacist in Melbourne, Fla., and a spokesperson for the American Pharmacists Association. Shepard is a clinical associate professor of pediatrics at Lucile Packard Children’s Hospital and Stanford University School of Medicine in Palo Alto, Calif.

Here is what they had to say about parents’ most pressing questions regarding the safety of over-the-counter drugs when kids take them.

Is it ever safe to use OTC cough and cold products in children under 2?

The short answer is no, says Tomaka. In no uncertain terms, the FDA states that OTC cough and cold products such as decongestants, expectorants, antihistamines, and cough suppressants should not be used in children under 2 years old. These products are not safe and do not work in babies and toddlers. What’s more, they may be misused and can cause serious and potentially life-threatening side effects.

Is it safe to use over-the-counter drugs for kids older than 2?

Again, the short answer is no. OTC cold and flu medications should probably not be used in kids under age 4. But, Tomaka says, it’s not as black and white as it is in kids under 2. The FDA is reviewing research on how -- or if -- over-the-counter cold and flu products affect older children. Nevertheless, manufacturers of pediatric cough and cold drugs are voluntarily putting a warning on their products that states children under 4 should not take these products.

Are over-the-counter cough and cold medications OK for kids older than 5?

“Short-term use of OTC cold products is OK if there is a clear diagnosis,” Tomaka says. These products should not be used for more than three to five days.

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“You can buy and give OTC cough and cold products to children aged 4 and over,” says Shepard. But talk to your doctor first, and never use more than one at a time.” She goes on to say, “Beware of combination products. There are many of them out there. Don’t give a cold medicine and Tylenol because the cold medicine may also have acetaminophen (the active ingredient in Tylenol) in it, and this can result in an overdose.”

The bottom line? “If the symptoms are mild, read the directions and use the product based on age and correct diagnosis,” Shepard says. “But if the symptoms are more severe, call a doctor and don’t give OTC medication. Call the doctor if your child has a high fever and is having breathing trouble such as chest pulling.”

How should a cough be treated, given all these rules and restrictions on OTC drug use?

“Cough suppressants may be appropriate in older children when the coughing gets miserable,” says Tomaka. ”But too often parents used these medications for mild, productive coughs.” A productive cough produces phlegm or mucus. Inappropriate use of cough suppressants can suppress the mucus, preventing it from being cleared from the lungs. If it remains in the lungs, the mucus can become infected.

“Overuse of cough suppressants for productive coughs can cause an increase in pneumonia and bronchial infections,” Tomaka says. The best rule of thumb? “If a cough is especially loud, productive or non-productive, and bothersome enough that it interferes with sleep, crying, or talking, call your pediatrician.”

Is baby aspirin ever OK to use in kids?

No way, no how, says Tomaka. Despite its name, “Baby aspirin is never to be used by babies,” he says. In general, baby aspirin should not be used for kids or teenagers except for certain conditions when prescribed by a doctor. Aspirin use in kids during a viral illness is linked to the development of Reye’s syndrome. This is a rare but potentially fatal illness that can affect the brain and liver.

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So how should fever or inflammation be treated in kids?

Acetaminophen is OK in children under 6 months of age. For older children, ibuprofen may also be used. “If there is severe inflammation, stiffness, and pain, such as after your child hurts her knee, ibuprofen may be the better choice,” Tomaka says.

Protect yourself and your family by reading the package labeling very carefully. Shepard says, “Taking too much is the biggest problem. That is why the FDA imposed its new rules.” She also advises steering clear of combination products.”

Shepard also points to the fact that some parents tend to switch off between acetaminophen and ibuprofen when treating a fever. Her advice is to talk with your pediatrician about this to see what he or she thinks.

If you can’t use cold or cough products in young kids, what can you do?

“Children should drink plenty of fluids to clear out their airways,” says Shepard. “Slightly warm liquids are helpful,” she says. “For young babies, put salt water drops in a dropper and squirt them in the nose and suck them out with a bulb to reduce congestion.” Saline nose drops are also available over the counter.

For children older than 1, honey can help soothe a cough. “A small amount of honey such as 1/2 teaspoon to a teaspoon mixed with warm water can soothe a cough before bed,” Shepard says. Honey is not recommended in children younger than one because it can increase the risk of botulism poisoning.

Is it OK to give vitamins or supplements?

It’s not a bad idea to encourage your children to eat foods that are rich in vitamin C or take vitamin C supplements when they have a cold. “This could help resolve symptoms more quickly,” Shepard says. Oranges, broccoli, strawberries, and bell peppers are loaded with vitamin C. Follow dosing instruction on vitamin labels carefully.

There have also been some concerns about the use of intranasal zinc in children. The FDA recently advised consumers -- including kids -- to stop using Zicam Cold Remedy Nasal Gel, Zicam Cold Remedy Nasal Swabs, and Zicam Cold Remedy Swabs, Kids Size (a discontinued product) because they are associated with the loss of sense of smell. This can be especially troublesome in kids, who may be less likely to tell you they can’t smell.

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What about OTC remedies for stomach ailments?

Talk to your pediatrician to find out what anti-diarrheal medications, if any, are safe for your child. “Keep up with fluid for vomiting or diarrhea because kids can get dehydrated and weak,” Shepard says. “Do not give OTC medicine if there is blood in the stool,” she adds. “If there is blood, you need a stool culture.”

For infants with gas, gas drops and OTC colic remedies, such as gripe water, are generally safe if you follow the directions on the label.

WebMD Feature Reviewed by Brunilda Nazario, MD on July 06, 2009

Sources

SOURCES:

Norman Tomaka, certified consultant pharmacist; spokesman, American Pharmacists Association.

Elizabeth Shepard, MD, clinical associate professor of pediatrics, Lucile Packard Children’s Hospital and Stanford University School of Medicine, Palo Alto, Calif.

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