McNeil Consumer Healthcare's voluntary recall of the company's infant and children's liquid over-the-counter medicines, while worrisome, does not leave parents without options for treating a child's cold or allergy symptoms. The widespread recall, which affects hundreds of thousands of containers of these drugs, is due to manufacturing deficiencies that the Food and Drug Administration says could affect the quality, purity, or potency of the medicines. Still, while the FDA is advising that you stop using the children's Tylenol, Motrin, Zyrtec, or Benadryl in your medicine cabinet for now, there are safe, non-drug alternatives, such as nasal suctioning and humidifiers, that can be used to ease a child's symptoms, experts say. (The FDA says it's OK to continue using generic versions of Tylenol or Motrin if your child experiences mild pain or fever.)
This isn't the first time concern has been raised about children's medicines. Bad effects in kids, even reports of deaths tied to improper use of pediatric cough and cold medicines, led the FDA to issue a public health advisory in 2008 saying that over-the-counter cough and cold products should not be used in children younger than age 2. Later that year, the Consumer Healthcare Products Association announced that pediatric manufacturers planned to voluntarily change medication labeling to advise against using the products in children younger than age 4.
[Read Cough Medicine Isn't for Kids.]
"These medications are used very commonly, and there is some risk. But parents assume there's no risk because they're [sold] over the counter," says David Tunkel, director of pediatric otolaryngology at Johns Hopkins Hospital and coauthor of a new commentary on the use of children's cough and cold medications, published in the May issue of Otolaryngology-Head and Neck Surgery. Moreover, viral illnesses usually resolve on their own, and when these medications are compared to placebo or improvement over time, "there is really not much benefit," says Tunkel.
The FDA is continuing to review the safety and effectiveness of all pediatric cough and cold medications. But the agency's 2008 advisory and subsequent changes in pediatric product labeling have led many parents to cut back on their use, the new commentary reports. What's more, the authors wrote, there isn't sufficient data to support OTC children's cold and cough medicines as treatments against upper respiratory tract infections, including colds, rhinosinusitis, and ear infections; the medicines may actually cause harm when given to young children with those illnesses. Since most simple upper respiratory infections clear up in about 10 days, it's usually fine to wait it out until your child feels better, says Tunkel.
The new recall aside, several factors play a role in the potential for harm from OTC cough and cold medications in young children, including the risk of overdose, giving adult medications to kids, and using more than one OTC medication at the same time, which can cause dangerous drug interactions. To avoid these risks, Tunkel recommends that parents stick with conservative remedies when children experience mild upper respiratory symptoms. Simple measures, such as saline sprays and nasal suctioning, should be used instead of OTC cough and cold medications in infants and young children, he says. Tunkel suggests the following alternatives:
Humidity. Humidifying the air is useful for cold symptoms because it helps the cilia, tiny hairs in the lining of the nose and sinuses, move mucus out of the nose.
Nasal irrigation and saline sprays or drops. Both saline sprays and nasal irrigation work by the same premise—decreasing the amount of mucus and crusting in the nose, which reduces congestion and obstruction. Nasal irrigation kits, including the neti pot and squeeze bottles, are sold over the counter along with packets of ingredients that can be mixed with water to create a saltwater solution to flush out the nose. Saline sprays and drops are also sold over the counter and can be sprayed into the nose safely, without irritating the nasal passages in children, according to the Mayo Clinic.
Both nasal irrigation and saline sprays or drops can be "helpful to allow [kids] to sneeze out the mucus so they're not stuffed up," Tunkel says. One caveat: Children younger than age 5 may have a tough time with nasal irrigation, since it requires coordination and an understanding of how the process works, he says. But older kids who understand how irrigation helps tend to do well with it.
Nasal suctioning. Using a bulb syringe to suck secretions out of the nose can help clear nasal passages in babies, Tunkel says. Parents should gently push the bulb into the nose no more than a half-inch deep. For best results, put several drops of saline solution into the nose before suctioning, the Mayo Clinic suggests.
This is an updated version of an article that was originally published on May 1, 2010.