At one time, there were so many cough and cold medicines on the market, that it took up entire rows of three shelves each at pharmacies and grocery stores. A parent would just stand there with a dropped jaw trying to select an
appropriate one. Since kids can average six to nine viral upper respiratory infections (colds) per year, an ample supply for the home pharmacy was a must. Of the hundreds of different
cold, cough, and allergies medications on the market, most contained the same four or five ingredients, depending on the brand. Some were decongestants; some were antihistamines; some were cough suppressants or expectorants, some had acetaminophen (Tylenol), and some had ALL of them.
Tens of millions of dollars were spent annually on medicines to loosen a cough, suppress a cough, loosen a stuffy nose, or dry up a stuffy nose. Medical providers routinely recommended these over-the-counter concoctions, since there was very little else we could do to help manage those annoying symptoms. Often, we would write a prescription for something “even stronger”, like a codeine-based cough suppressant, when a parent informed us that nothing seemed to be helping.
Then it happened. In spite of being on the market since most current adults were children themselves, studies started to appear in the medical journals that did not support their efficacy and safety. One by one, they were
pulled from the market, warnings added, and their over-the-counter sales restricted.
The first ingredient to go in 2000 was PPA — the decongestant, phenylpropanolamine. PPA was in lots of children’s cold medicines, as well as the main ingredient of an over-the-counter appetite suppressant. PPA was associated with an increased risk of stroke.
The next decongestant to be restricted was pseudoephedrine (Sudafed) primarily due to its illicit use in the manufacturing of methamphetamines. Even dextromethorphan — the DM in Robutussin DM and the sole ingredient in Delsym — is up for scrutiny and may be banned due to its recent
abuse by adolescents trying to get high on it.
In 2008, the FDA recommended against the use of all over-the-counter cough and cold medicine in children
under the age of two; soon to be followed by a recommendation not to use under the age of six (and even 12). The crowded shelves quickly became empty, and the products that parents faithfully used for children for decades were now gone.
There is a prevailing assumption that because a drug is over-the-counter, that it is safe. Nothing could be further from the truth. Before the FDA advisory, there over 1500 emergency room visits per year, including a few infant deaths, due to their use. In a one year period, over three-quarters of a million calls were made to Poison Control centers, mostly for over-dosages and adverse reactions. In a two decade period, there were 123 childhood deaths, mostly infants. The reasons for these deaths varied, but included overdosing, using adult-formulated products for children, use of multiple medications at the same time, failure to use an accurate measuring device, dosage confusion, and general misuse. Safe cold medicines in the careless hands of a sleep-deprived or careless parent can cause fatal consequences.
Have the restrictions helped? So far, yes. Emergency room visits in children over the age of two due to OTC cold medications have been cut in half. In older children, there does not seem to be a change.
Many medical providers continue to use and recommend them; perhaps not as often. I even caved in today and allowed parents of a five-year old to use them. They were desperate to get some sleep and the child was miserable. Besides, if I had just told them to use a vaporizer and squirt saline in his nose, I think my life would have been in danger.
There has been a push back to the things that your grandmother used, such as saline drops in the nose for stuffiness, and honey for cough control (in children over the age of one year). Although the jury is still out on the safety and effectiveness of Vicks VapoRub, I still smell it on a lot of kids, thanks to Grandma.
Just because people have been known to drown in salt water, does not justify removing saline from the market. Just because some child had an allergic reaction to honey or developed an intestinal illness from unprocessed honey, does not reduce its effectiveness as a safe cough suppressant. And just because I don’t care for the smell of Vicks, does not mean that Grandma shouldn’t rub it on our chests (although mine thought it worked better rubbed on the feet!) and does not mean it should be banned.
Most things in our lives can be dangerous if used incorrectly. The primary reason why millions of people can no longer use certain cough and cold medications is because of the small minority of people who ended up hurting their children with incorrect dosages.
In the end, it is still up to the medical provider to carefully explain ANY medication given or recommended to a patient, including how to properly dose and administer it. Mistakes are still going to be made — an inherent problem when dealing with imperfect humans. Our goal is to limit those mistakes.
Maybe someday — perhaps not in my lifetime — someone will find a cure for the common cold, or a vaccination that will prevent them. Until then, we all must suffer them from time to time, either in ourselves or in our children.
Source(s):http://blogs.webmd.com/all-ears/2011/06/cough-and-cold-medicines-for-kids-are-they-safe.html
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AAR11
