When a young child comes down with a cold — congestion, a scratchy sore throat and runny nose, maybe with greenish goo — many parents head straight for the drugstore for a bottle of children's cold medicine.
It's worth it to give children lots of fluid, acetaminophen or ibuprofen if they are uncomfortable and liberal doses of books, games and TV. But research has repeatedly shown that cold medicines do not work for children younger than 6, and they provide only a negligible benefit for children 6 to 12.
I notice two reactions when I share this information with parents in my pediatric practice: surprise, because these medications appear to work, though that's really just because cold symptoms naturally wax and wane throughout the day; and frustration that there isn't a medicine to just make the cold go away.
A common cold is the most frequent infection people get; more than 200 viruses cause these infections. Older children and adults tend to come down with a cold two to four times a year; young children get them six to 10 times a year. This is normal and not a sign that something is wrong with a child's immune system. Because colds are more common during the school year, some children will get a cold every month between fall and spring.
But a 2012 review by the Cochrane Collaboration, which looked at many studies done on the effectiveness of over-the-counter cold medication, reported that while antihistamine/analgesic/decongestant combinations provide some help to adults and teenagers, "there is no evidence of effectiveness in young children." Even for teens and adults, the review found that "adverse effects" sometimes experienced when using cold medicine, such as heart racing, drowsiness, dizziness and nausea, needed to be weighed against any benefit.
The truth is, a cold has a predictable life span, and not much can be done to interrupt it. When a child starts to get a runny nose, sounds congested and acts cranky because his throat hurts, you know a cold has settled in. The sore throat usually resolves in a couple of days, but it may be replaced by sinus pain, headache, muscle aches, a hoarse voice and cough.
Children are more likely to develop a fever with colds than adults. Nasal mucus turns from clear to yellow or green by the second or third day of the illness. Sleep may be interrupted, especially in babies and toddlers. Symptoms typically resolve by seven to 10 days but may last for two or three weeks. (Contrary to what many people believe, discolored nasal mucus usually does not require antibiotic therapy.)
So what's the parent of a sniffling, congested child with an achy throat to do? Several steps can help make a child more comfortable as his or her body naturally sheds a cold.
Vaporizers and cool-mist humidifiers moisturize the air in a room. They have no direct impact on the symptoms of a cold, but dry air can make a sore throat feel worse. Hot-air vaporizers that create steam should never be used around children because they boil water. Aromatic vapors have been used to treat colds for centuries, but few studies have been done to assess their effectiveness. A 2010 article in the journal Pediatrics showed an improvement in cough, congestion and sleep difficulty in children treated by applying a vapor rub containing camphor, menthol and eucalyptus to their chests. (More than a third of patients had side effects such as skin redness or a burning sensation of the eyes, skin or nose.) The study has been controversial, in part because the lead author was a paid consultant to a company that makes such a rub.
Saline (salt water) in the form of nose drops, sprays and solutions can also provide temporary relief in some people. There is no evidence that saline washes, which loosen mucus, reduce irritation and lessen dryness, shorten the duration of a cold. Keep in mind, though, that most small children hate having anything put in their noses, and fighting with them to instill drops or sprays could lead to a bloody nose and worse congestion.
No one has proved that drinking lots of fluids loosens mucus or makes a cold resolve more quickly. But it's common sense that keeping a child hydrated will make him feel better. I read a study years ago that showed that among the best fluids is chicken soup, because it loosened nasal mucus in adults. It has never been studied in children, but generations of grandmothers (including my own) have been firm believers in the medicinal value of chicken soup. So the next time your child has a cold, walk past the cold-medicine aisle at the supermarket and pick up some soup instead.
Howard Bennett is a Washington pediatrician.