Childrens Medical Office - of North Andover, P.C.

Introduction

One of our "pet peeves" is how purposefully confusing the drug companies make it for parents buying over-the-counter (OTC) medicines for respiratory symptoms. They hope that you will come back and buy another product when the first one doesn't work, thinking that you just bought the wrong one! Remember, there is no cure for the common cold. These medicines may temporarily relieve some symptoms, but at a price of some side effects. In general, we don't recommend them AT ALL for infants under 1 year of age, and we discourage them for children age 1-2y unless they are clearly allergic. Over age three they may be worthwhile at times, but you should KNOW WHAT YOU'RE BUYING. OTC (non-prescription) medicines for respiratory symptoms generally contain ANY COMBINATION of one, two, three, or all four of the following types of ingredients: Decongestants, Antihistamines, Expectorants, and Cough Suppressants.

Decongestants

These are usually long words starting with "P" such as pseudoephedrine and phenylpropanolamine. They constrict blood vessels throughout the body. In the nasal passages and throat this results in decreased swelling and discharge. Elsewhere it can result in elevated blood pressure and other side effects. Works to a limited extent in both allergies and viral illnesses, safe for young healthy individuals with normal blood pressure, and not a problem for breastfeeding baby although may reduce milk supply somewhat.

WHAT'S ALL THE HOOPLA IN THE NEWS
ABOUT PHENYLPROPANOLAMINE?

Antihistamines

Hundreds of types, but the most common OTC ones are Chlorpheniramine, Brompheniramine, Clemastine, Diphenhydramine. Blocks histamine, a chemical released in allergic reactions. Works great for true allergies, only so-so for viral infections. Thickens secretions - a two edged sword in that it may help certain symptoms but impede drainage from ears, sinuses, or make it harder to clear the lungs. Also causes drowsiness, irritability in some individuals. Won't HURT a breastfeeding baby, but again may somewhat reduce milk supply.

Expectorants

Supposedly loosen secretions, making them easier to cough up. The main one is guanefescien (sp?). Good idea, but probably doesn't work. No side effects. Safe for baby & breastfeeding. A glorified placebo, really.

Cough Suppressants (Antitussives)

Work to essentially NUMB the area of the brain that controls the coughing reflex, raising your cough threshold at a neurologic level. The main one sold is dextromethorphan ("DM") - a weak narcotic related to Codeine and Morphine but not as strong. These are a VERY BAD IDEA, in our opinion. We simply NEVER recommend them to anyone, at any age, in any situation, period. To interfere with the body's ability to cough, one of it's most basic and important defenses, without doing something about the cause of the cough, is dangerous and illogical. You may sleep better tonight but be more likely to wake up with pneumonia or a bad asthma attack.

Recommendations

Never use a product containing a cough suppressant.

Antihistamine/Decongestant combos are OK over age 1-2 for colds or allergies - our favorite Dimetapp (the "plain" or "cold & allergy" elixir - not the cough or "DM" formula). See dosing chart below.

Antihistamines alone are best for hives, itching, allergy symptoms - our favorite OTC versions are Benadryl for young kids in dose of 1 mg per kg body wt every 4-6h, Tavist-1 for children >6y who can take pills - 1 pill every 12h.

Decongestants alone are best for colds when wishing to avoid sedation/irritability. Best OTC versions are Dimetapp Infant Drops for younger kids and Sudafed for older kids. Sudafed can be given every 4-6h, 15mg per dose for age 3-5, 30mg per dose age 6-12, 60mg mg per dose age 13+

Don't double dose! Only one medicine from each category should be given at a time. Remember that many prescription medicines ALSO contain decongestants and antihistamines, so if your child is taking a prescription medicine be sure not to be using an OTC with similar ingredients!

DIMETAPP DOSING GUIDELINES:
Age	Infant Drops (Decongestant ONLY)	Decongestant/Antihistamine "Elixir" (Cold & Allergy)
6mo � 1y	� dropper (0.4cc)	Don抰 Give
1-2y	1 dropper (0.8cc)	� tsp (2.5cc)
2-4y	2 droppers (1.6cc)	1 tsp (5cc)
5-6y	3 droppers (2.4cc)	1� tsp (7.5cc)
7-8y	4 droppers (3.2cc)	2tsp (10cc)
9-12y	Use Sudafed (see above)	3tsp (15cc)
13+y	Use Sudafed (see above)	4tsp (20cc)