TORONTO - With cold and flu season starting, parents of young children can expect to face plenty of runny noses, bleary eyes and persistent coughs over the next few months.
While it's not the message any parent wants to hear, the Canadian Paediatric Society is issuing some frank guidance about how to treat kids' colds.
Their message: Cough and cold medications aren't advised for children younger than six, and other options like echinacea haven't been proven to prevent or mitigate colds in children.
In fact, they say, there's little that is truly useful except fluids, time and TLC.
"The answers are yes, time, patience, supporting the children while they are sick because they definitely suffer and usually the parents suffer with them," said Dr. Ran Goldman, a pediatrician and emergency department pediatric specialist at B.C. Children's Hospital in Vancouver.
Goldman wrote guidance on how to treat cough and colds in children on behalf of the Canadian Paediatric Society's drug therapy and hazardous substances committee. The guidance document was published Tuesday.
It is based on a review of the available scientific evidence on the efficacy of over-the-counter cold remedies, supplements like echinacea, zinc and vitamin C, humidifiers, antihistamines and even honey.
If you are a parent looking for a way to make it all better, the conclusions are rather bleak. Virtually nothing really works, the paper suggests.
There's no real proof over-the-counter cold and cough products work in children, but there's a fair amount of evidence use of these medications in kids can lead to problems. A U.S. injury surveillance system found that in 2004-2005, six per cent of emergency department visits by children under 12 that were related to medication use involved over-the-counter cold remedies.
"Parents perceive over-the-counter medications as safer than prescribed medications," Goldman explained.
"And this is a point we've been trying to educate parents around for a very long time. Medications — especially if they are combinations of medications — could be dangerous as well."
Cold medications are often combinations of antipyretics (fever lowering drugs), expectorants to dislodge mucus, decongestants, antihistamines and acetaminophen.
in 2008, Health Canada urged parents not to use over-the-counter cold remedies in children under six, and urged caution in their use in children over age six. The same winter, the U.S. Food and Drug Administration recommended parents not use the products to treat children under the age of two.
Humidifiers are a popular option when kids have colds. But after reviewing the studies on their use, the Cochrane Collaboration — a group that makes evidence-based medical recommendations — concluded there wasn't enough evidence to recommend the practice.
Most of the Paediatric Society's guidance was based on Cochrane Collaboration statements.
Over-the-counter pain medication helped with the discomfort of colds, but didn't significantly shorten the duration of them. Antihistamines had a small effect on runny noses and sneezing, but made kids drowsy. Studies suggested there was no proof echinacea worked, and the evidence on zinc was mixed.
Likewise the guidance doesn't recommend vitamin C as a treatment for children's colds.
Honey looks promising in some studies, but must be pasteurized and cannot be used in children under a year old, Goldman said. How might it be used — dissolved in hot water or by the spoonful? Goldman said there isn't evidence yet on which to make that kind of recommendation.