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Treatment Options for Cough and URI in Children

March 26, 2024

Written by Vivian Lei

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Clinicians have an important role in advising families on the appropriate evidence-based treatments for upper respiratory tract infections (URTIs) in children.

“So what can I do for my kid’s cold?”
This BMJ Practice Pointer article summarizes the existing evidence (or lack thereof) for cough and common cold therapies in children (aged 12 and under). Here are the key take-aways:

  • Analgesics and antipyretics are primarily for relieving discomfort and distress, rather than for their effect on fever since fever is a physiological response to infection and not inherently harmful.
  • Saline nasal irrigation relieves rhinorrhea and nasal congestion, although the benefit is small and short-lived.
  • Antihistamines alone and in combination with other agents have not shown any benefit in young children (6 months – 5 years), and adverse events are common.
  • Antitussives (e.g. dextromethorphan, codeine) are no better than placebo for cough and have a high risk profile.
  • Systemic steroids and heated humidified air have not been evaluated for cough in children.
  • Honey has the most evidence for effectiveness in reducing cough frequency, severity, and duration. There is also limited encouraging evidence for probiotics.
  • Provide counsel on medications that should never be given for URTIs: aspirin, honey in infants under 12 months, and antibiotics for viral infections.
  • Provide education on the natural course of URTIs:   
    • Treatments for the common cold do not shorten the length of illness.
    • Cough lasts for 10 days in 50% of children and 3 weeks in 10%.
    • Young children typically experience between 6-8 infections per year.

Interestingly, the authors included a nonmedical “parent adviser” who collaborated on the presentation and content of the article, highlighting the information that is most important for parents when seeking appropriate over-the-counter treatments for their children.

How will this change my practice?
Parents come to the ED seeking reassurance and guidance for their children with cough and common cold. It helps to remember that we can still provide valuable advice to parents and caregivers by demystifying over-the-counter medication labels and provide evidence-based recommendations regarding symptom management and the natural course of URTIs.

Source
Treatments for cough and common cold in children. BMJ. 2024 Jan 25;384:e075306. doi: 10.1136/bmj-2023-075306.