CPS Statement: Treating Cough and Cold

CPS Statement: Treating Cough and Cold

The following was adapted from the Canadian Paediatric Society’s statement on “Treating cough and cold: Guidance for caregivers of children and youth”. Please see the full statement for the full recommendations from the Canadian Paediatric Society.

The common cold is one of the most common pediatric presentations in general practice. Over-the-counter (OTC) cough and cold medications (CCMs) are widely used to alleviate symptoms, however their efficacy and safety has been questioned.  The following guidelines summarize the evidence for use of CCMs and reviews common alternatives for treating cough and cold.

Cough and Cold Medications (CCMs)

CCMs are usually a combination of several medications including antitussives, expectorants, antihistamines, decongestants and antipyretics. In 2008, Health Canada advised against the use of all CCM formulations in children less than six years of age and advised to use caution in children older than six years.

Lack of benefit - Meta-analysis has found no evidence for or against the use of CCMs in adults or children when assessing cough frequency or severity, sputum production, or physician assessment of illness.

Potential harm - CCMs have been shown to be responsible for 6% of total emergency department visits related to medication use in children less than 12 years of age; they have also been associated with pediatric deaths. Risk factors for fatalaties associated with CCMs in children include:

  • Age younger than two years.
  • Use of the medication for sedation.
  • Use in a daycare setting.
  • Combining two or more medications with the same ingredient.
  • Failure to use a measuring device.
  • Product misidentification.
  • Use of products intended for adults.

Other Investigated Treatments

The following common therapies have been investigated by systematic reviews and meta-analysis for symptom relief for the common cold.

Therapies with demonstrated benefit and rare adverse events:

  • Fluid intake - Maintains hydration and softens secretions in the respiratory tract.
  • Non-steroidal anti-inflammatory drugs (ie. Ibuprofen) - Shown to reduce discomfort or pain.  However, do not significantly reduce symptom scores or duration of a cold.
  • Honey - Shown to benefit cough frequency and severity, reduces pain and inflammation of mucous membranes, and may have antimicrobial effects. Safe in children older than 1 year of age.

Therapy with possible benefit but rare adverse events:

  • Humidified air - May enhance drainage of congested upper airways.
  • Vitamin C - May reduce frequency of respiratory infections when used for prophylaxis. No benefit shown for reducing symptoms during infection. No clear recommendations are given for optimal dose or potential adverse effects of regular use.

Therapy with unlikely benefit:

  • Antihistamines - May have a small effect on rhinorrhea and sneezing, but is countered by adverse events including sedation.
  • Echinacea - Shown to have no effect as a prophylactic measure to prevent the common cold.
  • Zinc - May inhibit viral growth, but benefits have not been consistently reproduced in research.  The CPS does not recommend use of zinc at this time.

Last updated by PedsCases: January 16, 2015

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