Dear Dr. B:
I read your recent column about the removal of infant cold medicines from the market. It sounded good at the time. I mean, I don't want to give my daughter stuff she doesn't need or that isn't safe. But now, guess what? She's got a cold and I've been up all night with her! I liked your evidence-based approach, so are there any proven therapies for colds in kids?
Sleepless in Haverhill
Great question! Cough is the most common reason for visits to the doctor's office. Children average six to seven upper respiratory infections (colds) a year. For kids in day care, that number can be closer to eight or 10. Considering that each cold lasts seven to 10 days, that's potentially a lot of sleepless nights for these sick kids and their exhausted parents. And now that cough and cold medicines designed for infants and young children have been taken off the market, many parents have been asking me that same question.
Alternative and herbal therapies such as zinc and echinacea have been studied as treatments for or prevention of colds for many years. The results have been mixed at best.
Echinacea has been postulated to modulate the immune system and enhance the ability of white blood cells to ingest germs. Unfortunately, a recent study comparing echinacea with placebo in children aged 2 to 11 years who had colds, failed to demonstrate a positive effect. In over 700 children with over 400 colds, no shortening of cold duration or decreased severity of cold symptoms was seen. Not only that, but children using the echinacea experienced rashes significantly more frequently than those using placebo.
Results for zinc were only slightly more promising. A recent review of the literature by a professor at Stanford University School of Medicine found that in the four studies of zinc that were the most rigorous, three showed no effect on severity or duration of cold symptoms. One study reported a positive effect using zinc nasal gel, but it was a study on adults which did not include children. Also, serious side effects of intranasal zinc have been reported, notably a permanent loss of the sense of smell.
Other potential problems with herbal remedies include contamination, poor packaging information and unknown toxicities due to the lack of research on safety and efficacy. Herbal therapies are not FDA approved or reviewed, and there are no official standards for purity and labeling.
One home remedy for cough relief that has gotten a lot of attention recently is honey. A study in December 2007 showed that honey was more effective than dextromethorphan, a common ingredient in many over-the-counter cough medicines, in treating cough from a cold.
The World Health Organization has long argued that honey is soothing to many patients and can help decrease cough associated with a sore throat.
We still don't know how it works. It may increase production of saliva and swallowing, or it may coat the nerve receptors that trigger cough. It's also possible that it influences the production of endogenous opioids, those "feel-good" substances responsible for the so-called "runner's high."
In any case, honey is cheap and apparently effective. It is also safe for most people. One important group for whom honey is not safe is babies under 1 year of age. Honey should not be used in this age group due to the risk of paralysis from botulism.
The point is, about the only known cure for the common cold is the tincture of time. With or without treatment, whether traditional or alternative, pharmaceutical or herbal, a good seven to 10 days generally does the trick.
Dr. Carolyn Roy-Bornstein is a board certified pediatrician with Merrimack Valley Child and Adolescent Health and Merrimack Valley Hospital. Her office is at Merrimack Health Center, 62 Brown St,. adjacent to the hospital. She can be reached at 978-521-8108. Parents are invited to e-mail questions for future columns to CRoy.MVCAH@comcast.net.