This is a problem, it takes time to change the notion that these meds help to any real extent.

Whitecoat: I don’t take it personally and I hope I didn’t offend or seem to attack anyone.

Here are a few examples of what I base my opinion on.
PEDIATRICS Vol. 108 No. 3 September 2001, p. e52
http://pediatrics.aappublications.org/cgi/content/abstract/108/3/e52
PEDIATRICS Vol. 114 No. 1 July 2004, pp. e85-e90
http://pediatrics.aappublications.org/cgi/content/abstract/114/1/e85
Cochrane Database Syst Rev. 2003;(3):CD001267
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=12917904&dopt=AbstractPlus

13: I am sorry your son had to go through what he did and it took another pediatrician to diagnose your child with something that was more than a cold. In retrospect it seems like kid always had RAD/Asthma from your story. Unfortunately your case does demonstrate some of what is wrong with these medicines. They only sedate kids and do little for the real symptoms. They make you think you are doing something good for your child when you could be masking the real culprit. And yes kids usually aren’t formally diagnosed with asthma until 2 or 3 years of age but RAD is commonly diagnosed in infancy and is the same illness. You probably know more about asthma now that your child is hopefully being dx/tx as such and probably have looked at the pediatric asthma guidelines. In the recommended therapies, there are no mentions of any of the commonly used cough/cold medications discussed.
I would also say that most asthma docs would prefer you start your rescues inhalers with the first signs of cough rather than wait for the cough medicines to stop the cough. Cough is a sign of URI/Cold but can also be the first sign of an asthma attack.

http://www.aaaai.org/members/resources/initiatives/pediatricasthma.stm

I think your last point is what I am trying to get at, “*think* they can do to help” and “The average person doesn’t have a clue about overdosing their child.” I would add they may not have a clue to dose correctly either. Is this safe?

Our acceptance of these medications in general have been based on the fact that the have worked on adults so they should work on kids. In fact, most medications we use were never initially studied in children.
Albuterol as an example… safety and efficacy never really studied in kids until xopenex came on the market.
It wasn’t until the late 1990′s that drug companies were required to test *new* drugs on children before they could be marketed. Most older drugs are “grandfathered” so they don’t need to be studied either. Ask your pediatrician the next time a drug is prescribed if it was testes in children.

Having these meds out there in pediatric friendly forms (i.e. liquids/meltaways) doesn’t make then any safer.

Your story reminds me of something that still happens though less frequently now that there are safer (and studied in children) medications. Prior to zofran (a previously costly anti nausea/vomiting medication), kids were often treated with adult medications for vomiting and nausea with medicines like tigan/compazine etc. These medicines are great in adults, you stopped puking and you went to sleep. Unfortunately when used in young kids, they did stop vomiting for a while, but were so sedated that they got more dehydrated from not drinking. Worse case scenarios, they had brain tumors and their vomiting was a another symptom that was being masked (seen in my still relatively new practice.)

My point after all this, these medications were never proven to be of benefit, there are real risks of injury, they are heavily marketed to parents (and physicians) and they are targeted at a population that is vulnerable and needs to be protected.

I am up at 5:31 California time because my 11 month old has a cold and his cough has woken him up several times tonight. Is he in distress, no but he is definitely uncomfortable. I do wish there was something I could do to make him feel better faster but I am doing what I *know/think* is best for him and what I tell my patients to do, look for signs of respiratory distress, encourage fluids, and manually “suck the snot out.” That’s the best modern medicine has for a cold in children.

“Michelle, there are no “kids” version of any of these medicines. Most were never tested in children, just extrapolated down. Dextrometophan is the same in delsym as it is in any other medication, just a liquid with flavoring added.

Has your child ever been diagnosed with “a chest cold,” “touch of pneumonia” or “bronchitis,” after having a runny nose for a few days?”

This is a can of worms I do not want to open because it would turn into a long vent and hijack this post.

Yes…. he was diagnosed with reactive airways disease. This was after basically arguing with a doctor and spending many MANY sleepless nights with him coughing until he vomited, watching him turn blue in the face, unable to catch his breath, sitting up, holding him upright in a steamy bathroom to ease his breathing. He had numerous bouts of viral pneumonia and two episodes of bacterial pneumonia.

The argument was me telling the ped he was wheezing and the doctor telling me that “kids that age can’t have asthma.” The change came when I got angry one day at the 4th time my son coughed until he vomited and was unable to breathe, so I took him as a walk-in to the clinic and said, “Do something NOW. This has to stop.” He saw a different pediatrician who took a chest x-ray and saw air trapping. His pulse oximetry was 90%. He was given an albuterol treatment along with Pulmicort, and after that we got both a home nebulizer and a couple of MDIs.

The thing is, now, for us, he is older…. he can have a little cough syrup to suppress that urge and be okay. If this doesn’t keep the coughing at bay, we start albuterol to keep his airways open. However, if we don’t suppress the cough, then we have problems, as it becomes a self-perpetuating thing…. he coughs, which irritates his throat/airways, and he coughs more.

Interestingly, my son also has cold urticaria. We’ve seen an allergist (of course, cold urticaria can’t be diagnosed on any type of allergy testing, other than with an ice cube applied to his skin); however, he has an elevated C4.

My point about people giving kids adult medicines is just that: There are people who can’t afford to go in and see a doctor every time their child gets a cough, and if they do, they may be met with sarcasm and disdain. They will resort to whatever measures they *think* they can do to help their child rest and improve. Is it better to have these things in manageable doses, or do we want people trying to play junior pharmacist to figure out how much to give to their kids?

The average person doesn’t have a clue about overdosing their child. All they know is their kid can’t sleep because he’s hacking up a lung, they’ve got to sleep and be to work in 5 hours, and there has to be something in here in the medicine cabinet to help them sleep. Here, let’s try some NyQuil…

#2 Who gets to choose? Someone should. Should we go back to snake oils for rheumatism? Remember, this panel is NOT the FDA, they’re an advisory committee to the FDA though the FDA follows this groups’ recs. There are lots of medications with side effects like chemo meds, AIDS, etc but the side are worth the risk. They all have to prove that they have some efficacy in large populations of people. N of 1 is not scientific proof.

You say lets get rid of them all in jest but we might almost be better off if the FDA did. How many medicines commonly prescribed for children have ever been tested in children not counting OTC’s? The percent is dismal (albuterol/morphine are two examples that come quickly to mind). Necessity and common sense dictates our use of these medicines until something better studied appears.

#3 If the side effects are a health risk why not? Children are a vulnerable population. Who looks out for them?
Narcotics and Ritalin are prescription medications taken (hopefully) under supervision of a doctor.

Should we put cigarettes back on the shelves and allow anyone to buy them because not everyone gets cancer? Lower the drinking age to 15 because 25 years olds dont drive? Stop giving vaccines because kids can have fever afterwards?

OTC cough and cold meds are not the same.
Your kids may respond well, that’s good if they get symptomatic relief.

Does it make their actual colds go anyway any faster? Does it prevent it “from going to their chest”? Does it prevent that pneumonia? Does it prevent that “sinusitis”?
Probably not but that is the assumption that parents are going on.

Heard this before?
“My baby had a cold over the winter and it “turned into” RSV. He hasn’t been sick all summer because as soon as he gets a cold i give him dimetapp to prevent it from going to his chest.”

The FDA is trying to do a job (how well, I don’t know) and as a physician I think you should look at the body of literature that is available and come to scientific conclusion that is supportable with info available at the time.

Slippery slope or a step to protect children? You talk about patient asking for antibiotics. This is a similar scenario. Asking for meds that could be dangerous for mild-moderate symptoms that will improve in a few days.
I guess you could give them antibiotics for that 5-10% of URI’s that are bacterial because then you know those 5-10% would get better.

BTW had a patient with an allergic reaction to Delsym last night. Swelling of the lips and urticaria.

Has your child ever been diagnosed with “a chest cold,” “touch of pneumonia” or “bronchitis,” after having a runny nose for a few days?