Cold medications are often taken by patients to help relieve symptoms such as a runny or stuffed-up nose, coughing and sneezing. Many parents also give these medications to children with cold symptoms.

The common cold has no cure. It is caused by viruses and may involve nasal congestion, coughing and sneezing. Cold medications sometimes provide relief from symptoms, but that relief may only be in the form of drowsiness or greater ability to rest. The use of cold medications in children is a source of controversy. Many experts contend that there is no evidence that cold medications alleviate cold symptoms in children. Parents may believe that anything that helps a child rest better or appears to alleviate symptoms can help their children.  

Many medications are available to treat the symptoms of colds. Some of them are more commonly used to treat similar symptoms associated with allergies (e.g., sneezing and a runny nose). They include:

• Antihistamines. Help to stop a runny nose, itchy eyes and sneezing in patients with allergies. Experts consider these medications to be ineffective for treating colds. However, they are often marketed as part of cold medications or sold in combination with decongestants.
  
  
• Decongestants. Medications that help relieve stuffiness associated with colds or allergies. These drugs temporarily shrink the blood vessels in the lining of the nose, reducing swelling of nasal tissues.
  
  
• Combination medications. Some cold medications combine a decongestant with an antihistamine. Other medications combine other ingredients, such as pain relievers.
  
  
• Cough syrups. There are two kinds of cough medications. Expectorants help loosen mucus, and suppressants prevent the patient’s cough reflex from activating.

Patients of all ages should tell their physician about any illness or allergies before taking cold medications. Though most cold medications are generally considered to be safe, they may present health risks – some of which can be fatal – when they are taken by children at excessively high dosage levels or when taken at correct dosage levels over long periods of time. In addition, children may receive excess dosages if a parent is not aware of duplication of ingredients in separate medications.

Side effects associated with cold medications include agitation or drowsiness, high blood pressure, and insomnia. More serious symptoms such as chest pain, loss of contact with reality (psychosis) or seizures may indicate an overdose, which requires immediate medical attention.

Parents are urged to consult with a physician about the potential risks and benefits of using cold medications before deciding whether these drugs are appropriate for a child. All cold medications should be kept locked away from children and only administered with a parent’s supervision.

Cold medications are often taken by patients of all ages – including children – to help relieve symptoms such as a runny or stuffed-up nose, coughing and sneezing. In adults, the medications may provide relief from some symptoms, despite the fact that they cannot stop or shorten a cold. However, the use of these drugs in children is a source of controversy. Though many parents maintain that these drugs help their children to better endure cold symptoms, some experts contend that there is little or no proof that cold medications are effective when used by children.

Colds are a regular part of a child’s life, with the average child experiencing six to 10 colds each year that typically last for 10 days to two weeks. There is no cure for the common cold, but these infections typically are relatively harmless and resolve on their own over time.

A child with a cold may experience symptoms such as runny nose (rhinorrhea) and cough that generate major discomfort. As a result, parents often turn to cold medications to relieve these symptoms. There are scores of these medications available in various combinations that include substances such as decongestants, cough suppressants, antihistamines, antipyretics (which reduce fever) and analgesics (which reduce pain).

According to the American Academy of Pediatrics (AAP), studies have failed to show any proof that cold medications help young children. In particular, these drugs should not be used in children 2 years of age or younger. In this population, these medications can be harmful and sometimes even life-threatening, according to new research. Cold medications may be more effective in treating symptoms related to adolescents and adults.

Although most cold medications are generally considered to be safe, they may present health risks – some of which can be fatal – when they are taken by children at excessively high dosage levels or when taken at correct dosage levels over long periods of time. Parents may not consider over-the-counter cold remedies to be medications when a physician asks if the child has taken any medications. In addition, dosage guidelines for children have traditionally been based on information gathered about adult usage and therefore are not considered to be especially precise. Parents may initially give a child a recommended dosage, but increase the dosage, expecting that a higher dosage may provide additional relief. In some cases, this may worsen symptoms.

In recent years, the Food and Drug Administration (FDA) has asked all drug manufacturers to remove the ingredient phenylpropanolamine (PPA) from over-the-counter decongestants. It is suspected that this ingredient may lead to an increased risk of hemorrhagic stroke (bleeding in the brain that damages brain tissue). Most drug manufacturers have worked to either remove medications that contain PPA or replace PPA with other ingredients.

Many experts urge parents to avoid using cold medications in children if possible. Cold medications cannot prevent or reduce the length of a cold. At best, they can control symptoms, and whether they are effective at all in children remains a topic of debate. Studies have shown that the sedative quality of many of these medications often fools parents into thinking the drugs are working, when in fact they have little or no impact on a child’s symptoms.

There are many different types of cold medications available. It is important to note that many experts contend there is no proof that these drugs work in children. Parents are urged to consult with a physician about whether cold medications should be given to a child, and whether the potential benefits outweigh the risks of side effects.

The major types of cold medications include:

• Antihistamines. These drugs are known to relieve a runny nose, itchy eyes and sneezing in patients with allergies. Experts consider antihistamines to be ineffective for treating colds. However, they are often marketed as part of cold medications or sold in combination with decongestants. Antihistamines are known to cause side effects in some children, including nightmares, unusual excitement, nervousness, restlessness and irritability.
  
  
• Decongestants. Drugs that help relieve stuffiness associated with colds or allergies. These drugs temporarily shrink the blood vessels in the lining of the nose, reducing swelling of nasal tissues and improving breathing. In children, oral decongestants may cause hyperactivity, anxiousness, racing heart or insomnia. They may also cause a “rebound” effect in which the medication becomes less effective and symptoms return in a worse form than when they began. They may also cause blood pressure increases in children. Decongestants should not be used in infants, who may absorb too much of the drug through their nasal membranes.
  
  
• Combination medications. Some cold medications combine a decongestant with an antihistamine. This can cause side effects such as hyperactivity, insomnia and irritability. Other medications combine other ingredients, such as the pain relievers. It is crucial for parents to avoid giving their children too much of certain kinds of medications. Thus, children who are taking a certain pain reliever to control a fever should never take a cold medication that also contains the same pain reliever, because this can lead to a dangerous overdose.
  
  
• Cough syrups. There are two kinds of cough medications. Expectorants help loosen mucus, whereas suppressants prevent the patient’s cough reflex from activating. Experts generally advise against giving suppressants to children, because coughing can help clear the lungs. It is especially important not to give children cough syrups that contain codeine.

Patients of all ages should tell their physician about any illness or allergies before taking cold medications. In addition, certain medical conditions (many of them more common in adults) may preclude the use of cold medications. These include:

• Anemia (reduced levels of red blood cells)
  
  
• Diabetes mellitus
  
  
• Enlarged prostate or urinary tract blockage
  
  
• Glaucoma (disease that causes increased pressure in the eye)
  
  
• Gout (uric acid build-up in a joint)
  
  
• Heart or blood vessel disease
  
  
• High blood pressure (hypertension)
  
  
• Kidney disease
  
  
• Liver disease
  
  
• Portal hypertension (rare lung disorder in which blood pressure in the pulmonary artery rises far above normal)
  
  
• Thyroid disease

Children who take over-the-counter cold medications may experience dried-out respiratory passages and thickened nasal secretions. Overuse of nasal decongestants can lead to a “rebound effect” in which the drug becomes less potent and nasal congestion begins to worsen.

Other potential side effects associated with cold medications include:

• Agitation
• Anxiousness
• Dizziness
• Drowsiness
• • Fast heartbeat (tachycardia) or slow heartbeat (bradycardia)
  • Fatigue
  • High blood pressure (hypertension)
• High blood sugar levels
• Hyperactivity
• Insomnia
• Irritability
• Loss of appetite (anorexia)
• Nervousness
• Nightmares
• Racing heart
• Restlessness
• Retention of urine
• Unusual excitement
• Upset stomach

Symptoms of overdose can be similar to the medication’s side effects, but are usually more severe. Overdoses may cause hemorrhagic stroke (bleeding in the brain that damages brain tissue), dysrhythmias (abnormal heart or brain rhythms), myocardial infarction (heart attack) or ischemic bowel infarction (death of intestine portion after its blood supply is cut off). Children who overdose on the ingredient phenylpropanolamine may experience hypertensive encephalopathy, a brain disease resulting from high blood pressure. Parents who notice their child exhibiting any of these symptoms should contact a physician immediately:

• Blurred vision
• Chest pain
• Lethargy or stupor
• Loss of ability to control muscle movements (ataxia)
• Loss of contact with reality (psychosis)
• Seizures
• Significant headache
• Significant agitation

Preparing questions in advance can help parents have more meaningful discussions with a physician regarding a child’s treatment options. The following questions related to cold medications and children may be helpful:

1. Should my child use cold medications, or are they a waste of time?
   
   
2. What are the major risks associated with a child’s use of cold medications?
   
   
3. What alternatives are available for treating cold symptoms?
   
   
4. Do you believe that cold medications sometimes should be given to children?
   
   
5. What is the appropriate dosage for my child?
   
   
6. How often should I give the medication to my child?
   
   
7. If I decide to give my child cold medications, which ingredients should I try to avoid?
   
   
8. If I decide to give my child cold medications, what side effects should I look for?
   
   
9. What steps can I take to make sure my child does not overdose on cold medication?
   
   
10. How will I know if my child has overdosed on a cold medication? What symptoms indicate a medical emergency?
    
    
11. What should I do if my child starts reacting adversely to a cold medication?
    
    
12. Are there certain medical conditions or other factors that preclude the use of cold medications?