October 9, 2008

Cold Medicine Companies See Writing On Wall, Slap Warning On Box

Truly, nothing inspires confidence and medical credibility than hearing a big pharmaceutical company trumpet the safety of their children's cold medicines one week and then suddenly do a 180 and announce a voluntary [sic] ban on those same meds for half the market.

While that's not exactly what happened this week, it's clear that makers of over-the-counter cold meds for kids 6 and under are doing exactly what they did last year in the 2-and-under market: throw up a concessionary voluntary limit in hopes of heading off an outright FDA ban. Good luck with that.

The newly announced labeling would tell parents not to use OTC meds on kids under 4, since they make up the majority of overdose- and complication-related emergency room visits. They'd also instruct not to use antihistamines for sedation. "While many parents believe that getting a sick child to sleep is the best medicine, the use of sedatives is widely discouraged by medical experts, who say they can worsen breathing problems caused by illness."

ORLY? And is it possible that medical experts didn't notice until now that the entire children's cold medical universe might be oriented around getting sick children to sleep?

Look, Benadryl may very well be the opium-laced Mother's Sleepy Tyme Elixir of the 21st century, and we'll all be looked back on by our grandkids as clueless barbarians.

But as I've been following this FDA crusade the last couple of years, I can't help but feel the story keeps changing: the problem is overdosing and combination medicines, then there's no research, then the drugs actually don't even work. A couple of weeks ago, meds were bad because there's no cure for the common cold, just the symptoms, but now it's only 3-year-olds who overdose, and oh yeah, the sleep we promised? Exactly the wrong thing to do.

Until I see something conclusive, or at least persuasive, I'm gonna stay on Team Sleep for a while.

Child Warning Added to Cold Remedies [nyt]


I do buy that antihistamines in some cases can be detrimental even if dosage is correct... if the child has pneumonia or apnea or something that makes it difficult for them to breathe (beyond the ordinary snots), the sleep induced by Benadryl may potentially be deep enough that the child can't rouse properly to resolve a breathing crisis.

But yeah, like you said, hard to know for sure what's really best for the kids when the story keeps changing.

Team Sleep... sure... I get it.

But the distinction you're missing (or ignoring for dramatic effect?) is medicating to relieve symptoms and thus *allow* sleep vs. medicating to *induce* sleep. The second one being what "the use of sedatives" refers to. I'm guessing, though, that the first one's what you've got in mind.

Of course now we're back to the problem of whether these drugs really do anything to relieve symptoms in the first place, which, despite how the story's come across to you, I'm quite sure has been a key factor in the equation from the beginning. When kids die because they're given drugs that can't be proven to actually do anything to help them, medical professionals have a tendency to start a crusade (as you put it).

As far as 4 years old being a pretty arbitrary point of separation: welcome to medicine.


As for me? Those cold medicines obviously help my little ones when they're sick. Helps them breathe through their nose, which helps them sleep, which (I believe) helps their bodies fight the cold.

I'm puzzled by all this "they don't even work" talk. They work well at my house... and I'd hate to have to get through cold season without them.

...and it makes no sense to me to pull effective medicines off the shelf because a few dumbass parents are not using them correctly. Harrumph.

a good distinction that I'd welcome on the sedative vs sedation angle. I'm not a fan of the whole drug'em to fly, drug'em so *I* can sleep approach to parenting, which does remind me of the 19th c. practice of knocking kids out with opium all day so their parents could go to work in the factory. And if 4yo is the 80/20 breakpoint, or the most easily propagated from a PR/adoption standpoint, then I'm fine with arbitrary. It's just that the justifications and rationales seem to only dribble out piecemeal. It's hard/annoying to know what to believe when it seems like the expert/authoritative story is always morphing.

While we're certainly not radically anti-OTC drugs, we've never given our 2.5 yr old daughter any OTC cold meds (other than benadryl for a bee sting). When she gets a cold we've relied on what a doctor friend of ours claimed: almost none of those meds help anyone (child or adult) as much as a humidifier, saline nasal spray, blowing your nose, drinking fluids, and getting your vitamins through a well-balanced diet and/or supplements.

So far it seems to have worked...it makes a huge difference to have the humidifier, especially in the cold, dry winters of the midwest. Since it has worked so well for our daughter my wife and I have also stopped taking OTC cold meds and we've found that while the first day or two sucks, the recovery is easier and we're less drowsy and medicated feeling so we can return to regular work/parenting duties more easily.

I avoid over the counter medications for my kids. A little honey and lemon tea and a humidifier work wonders.

It is best to avoid the OTC medications unless specifically recommended by your pediatrician. Along with a humidifier and the other recommendations, I have found the vicks vapor strips that you stick in a plug-in device can be helpful to alleviate the stuffiness. Haven't tried the vap-o-rub that I remember being put on me as a kid. I hated that stuff!

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