When your child is sick with a cold or flu what medicines should you get? When patients ask me, for nearly 20 years I have had the same response, “None, in general they don’t work and are a scam.” It is hard to find evidence that over-the-counter cold medications do anything but take away money that could be used for more important things that families and children desperately need, but since every parent wants their child to feel better, they are very hard to resist.
Recently the Food and Drug Administration (FDA) passed an unanimous vote on 9/12/23 that stated the most common decongestant, phenylephrine, is ineffective. I was thrilled when I saw this, but we have known this for 20 years, so I am not sure why it took that long to hopefully save people a lot of money. How much money do you ask? Americans spent 1.76 BILLION dollars on over-the-counter cold medicines with phenylephrine last year - all for nothing. The other decongestant does work but, since you can use it to make illegal drugs, is sold only by the pharmacist without a prescription to adults. That medicine is called pseudoephedrine. It works well, but makes it nearly impossible to sleep and is not safe with people with blood pressure problems or heart conditions, but for many adult sized teens it is a helpful medicine to take in the morning to get through a day of school without blowing their noses all day!
What about cough suppressants? First, remember that coughing itself isn’t necessarily a bad thing. It is your body's reflex to protect itself by “getting things up” and not drowning in snot, but yes, sometimes it can get out of hand and make kids really miserable. Dextromethorphan is the most common “cough medicine” and drumroll - there is no evidence it works either. What is worse for parents with teenagers, is that at high doses dextromethorphan will cause a buzz, hallucinations, intoxication, and a feeling of having an out of body experience. Unfortunately, teens have figured this out, and have been abusing the non-effective cough medicine for recreational purposes, which can be very dangerous.
So, what should you do? First, now that you know cold medications don’t work, you can feel guilt free not buying them when your loved one is sick. You can definitely try 5 ml of honey every 6 hours for cough (for kids over 1 year old), which has some evidence for helping. You can run a humidifier in the room, which can make the coughing more comfortable. Definitely don’t forget ibuprofen for aches, pains, and irritability. Lastly, make sure to get your covid and flu vaccines to decrease the number of total illnesses your child has per year. If your child has a wheezy or croupy cough, or it is getting progressively worse or the cough is accompanied by a fever after the fifth day of illness, definitely go see your doctor!
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