Doctors More Likely to Recommend Antihistamines Than Cold and Cough Medicine in Children

Aislinn Antrim
Published Online: Wednesday, August 14th, 2019
A recent study found that physicians are more likely to recommend antihistamines than cough and cold medicines for children under 12 with respiratory infections.
 
While cold and cough medications are not recommended for children and antihistamines are widely used over-the-counter drugs to treat various allergic conditions, they have little known benefit for children with colds. Furthermore, some older antihistamines can cause sedation and occasionally agitation in children.1
 
The researchers noted a sharp decline in cough and cold medication recommendations for children under 2 after 2008, when the FDA warned against the medications for that age group due to safety concerns. Following that FDA recommendation, the American Academy of Pediatrics recommended avoiding cough and cold medicines in children under 6.
 
After the 2008 public health advisory, the researchers found that physician recommendations declined by 56% for non-opioid cough and cold medicines in children under 2, and by 68% for opioid-containing medicines in children under 6.
 
Cough and cold medications can have serious side effects in children, including slow breathing, which can be life-threatening. The FDA especially warns against use of codeine-containing medications in children under 18. Caregivers should closely read labels on OTC cough and cold products.2
 
The researchers used national surveys representing 3.1 billion pediatric ambulatory clinic and emergency department visits in the U.S. between 2002 and 2015. During that time, physicians order approximately 95.7 million cough and cold medications, 12% of which contained opioids.
 
“Families often treat their children’s respiratory infections with cough and cold medicines, some of which include opioid ingredients such as codeine or hydrocodone,” said study lead author Daniel Horton, MD, MSCE. “However, there is little proof that these medications effectively ease the symptoms in young children.”
 
Co-author Brian Strom, chancellor of Rutgers Biomedical and Health Sciences, warned that antihistamines are not necessarily a solution, however.
 
“It’s nice to see physicians are heeding the advice to avoid cough and cold medications for children, but switching them to antihistamines is not necessarily an improvement,” Strom said.
 
The American Academy of Pediatrics has several recommendations for treating a child’s cold or flu. For a stuffy nose, they recommend nasal sprays or a cool-mist humidifier, which can thin the mucus. For a cough in children over 1 year old, they recommend honey or mentholated rubs. Children 4 or older can use cough drops or lozenges to reduce a cough. Acetaminophen or Ibuprofen can effectively treat a fever.3

References
  1. Daniel Horton, Tobias Gerhard, Brian Strom. Trends in Cough and Cold Medicine Recommendations for Children in the United States, 2002-2015. JAMA Pediatrics, 2019; DOI: 10.1001/jamapediatrics.2019.2252.

  2. U.S. FDA. When to Give Kids Medicine for Coughs and Colds. U.S. Food and Drug Administration. https://www.fda.gov/consumer-updates/when-give-kids-medicine-coughs-and-colds. Published July 18, 2017. Accessed August 13, 2019.

  3. Caring for Your Child’s Cold or Flu. HealthyChildren.org. https://www.healthychidlren.org/English/safety-prevention/at-home/medication-safety/Pages/How-to-Manage-Colds-and-Flu.aspx. Updated April 19, 2019. Accessed August 13, 2019. 


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