Decoding Cough And Cold Medications
I was recently at the store and went to the cough and cold aisle. There was a mom standing there with an obviously sick kid in the cart. She was just staring at all the meds and looked like she was about to cry. I generally try not to offer friendly, unsolicited advice to strangers (strange, people usually don’t like it), but I decided to speak up in this case. When I told her I was a pediatrician and asked what her child’s symptoms were, she nearly fell into my arms with relief for the help. So I thought I’d pass on a few tips
Age: (Limitations are based on safety data)
- Under 2 months: See your doctor.
- 2-6 months: Very limited options. Try Tylenol (generic is Acetaminophen), saline nose drops (to loosen and suck out boogers), and a cool mist humidifier.
- 6-12 months: Still limited options. All the above, but can add Motrin (generic is ibuprofen).
- 1-4 years: All the above, but can add honey. Give it plain or mix it into a tea, etc. Honey has been shown to help some with cough.
- 4-6 years: All the above, with caution using cough and cold medications. FDA says yes on cough and cold meds over 4 years. AAP (The American Academy of Pediatrics) says over 6 years before using cough and cold meds.
- 6+ years: All the above, plus cough and cold medications.
Decoding the medications:
- Dextromethorphan (DXM or DM): Used as a cough suppressant. Commonly found in Delsym, Robitussin, Dimetapp, Coricidin, Mucinex DM, etc. If your kid has a cough, find a med with this in it.
- Pseudoephedrine (PSE): Used as a decongestant (helps with the runny or stuffy nose). Found in Sudafed, Tylenol Cold, Robitussin, Benedryl Cold, etc. It may be more effective than phenylephrine, but it is regulated closer (it is used in the manufacture of methamphetamines). As an aside, the FDA warns against using long-acting or extended release preparations of pseudoephedrine to kids under age 12.
- Phenylephrine (PE): Used as a decongestant (again helps with the runny or stuffy nose). Meds generally have pseudoephedrine or phenylephrine, but not both. Found in Sudafed PE, Triaminic, etc. The data is hit and miss on the effectiveness of phenylephrine.
- Guaifenesin (GG): Used as an expectorant (helps loosen and bring up the phlegm). Found in Mucinex, Duratuss, and Tylenol Complete Cold, Cough & Flu. Medically, I am not sure why cough suppressants and expectorants are put together in combination medications. It is counter intuitive (one stops the cough while the other is trying to bring the stuff up). For that reason, I never buy combination medications with Dextromethorphan and Guaifenesin together. (Note: This is my personal opinion here).
- Acetaminophen (APAP): Used as a fever reducer and pain reliever. Trade name Tylenol. Either Acetaminophen or Ibuprofen is in almost all combination cold medications. Advantage over Ibuprofen is that Acetaminophen is easier on the gut and fewer side effects, but shorter acting (4 hrs.).
- Ibuprofen (IBU): Used as a fever reducer and pain reliever. Trade name Motrin. Either Ibuprofen or Acetaminophen is in almost all combination cold medications. Advantage over Acetaminophen is that Ibuprofen has an anti-inflammatory effect and lasts longer (6 hrs.), but is harder on the gut.
- Chlorpheniramine maleate (CPM): Used as an antihistamine (helps dry up secretions, usually associated with allergies). There isn’t much of a place for allergy meds in colds, unless there is an allergic component playing into the symptoms. Antihistamines are often added to the “nighttime” medication versions, because of the sedating side effects of antihistamines.
- Diphenhydramine (DPH): Used as an antihistamine. Active ingredient in Benedryl (see explanation for #7).
- Doxylamine Succinate: Used as an antihistamine (see explanation #7).
Wow, that is quite a list. It’s not exhaustive, but should cover 90% of the meds out there. If you got lost, here’s the very short of it: Choose the medications with the smallest amount of ingredients to cover the symptoms. Never give your kid a medication that he doesn’t need. If your child has a cough, choose something with just dextromethorphan (like Delsym). If there is a stuffy nose only, choose just pseudoephedrine (like Sudafed). If you choose single-drug meds, you can add Acetaminophen (Tylenol) or Ibuprofen (Motrin) in addition for fever/pain relief. If the med you choose has Acetaminophen or Ibuprofen, don’t give either in addition or you’ll risk overdosing. Generally limit the medications with antihistamines to nighttime, or shy away altogether. Always dose children’s medication based on weight, not age. Hopefully this helps you as you navigate what meds to use.
Small disclaimer: If your child has any one symptom that is particularly worrisome (e.g., a terrible cough), has gone on for a long time (i.e., more than 10 days), or makes you worried that it is more than just a common cold, you should see your doctor. Also, I didn’t specifically address the role of herbs and alternative options in this article (it’s a whole topic on its own).