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Doctors should steer young children away from decongestants

Under six-year-olds should not have decongestants, say experts

Adrian O'Dowd

Thursday, 11 October 2018

Doctors should recommend that children aged under six not take decongestants for common cold symptoms, suggests a study* published today in The BMJ.

In addition, decongestants should only be given to children under 12 with caution because there is no evidence that they alleviate symptoms such as a blocked or runny nose and their safety is unclear, said researchers.

The common cold is usually caused by viruses and symptoms usually clear in seven to 10 days, but it can have a substantial impact on work, school, use of health services, and money spent on medications.

Children have around 6-8 colds per year while adults have 2-4 colds.

Professor Mieke van Driel from the Faculty of Medicine, University of Queensland, Brisbane, Australia and colleagues analysed published evidence on the effectiveness of treatments for the common cold.

For adults, existing evidence suggests that using decongestants alone, or with antihistamines or analgesics, for a maximum of three to seven days can have a small effect on nasal symptoms.

However, side effects can include an increased risk of insomnia, drowsiness, headache, or stomach upset. Long-term use of decongestants can also lead to chronic nasal congestion.

Evidence also shows that paracetamol and anti-inflammatory drugs (NSAIDs) are sometimes prescribed for pain relief, but they do not appear to improve nasal congestion or runny nose.

Other treatments, such as steam inhalation, echinacea, vapour rub, eucalyptus oil, and increased fluid intake, are either not effective or have not been studied at all. Trials are also lacking for children, especially those under 12.

The authors said that decongestants or medicines containing antihistamine should not be given to children under six and they advise caution between six and 12 years.

“There is no evidence that these treatments alleviate nasal symptoms and they can cause adverse effects such as drowsiness or gastrointestinal (stomach) upset,” they said, adding that in children under two, they have been associated with convulsions, rapid heart rate and death.

There was also inadequate evidence that any of the other commonly used over-the-counter and home treatments, such as heated humidified air, analgesics, eucalyptus oil, or echinacea, worked well.

“If parents are concerned about their child’s comfort, saline nasal irrigations or drops can be used safely, but this may not give the desired relief,” they wrote.

Ongoing research was unlikely to provide relevant evidence or address the uncertainty surrounding treatments for the common cold, they added, concluding: “Based on the currently available evidence, reassurance that symptoms are self-limiting is the best you can offer patients, although short term use of decongestants in adults can provide some relief from a blocked nose.”

*Van Driel, M L, Scheire S, Deckx L, Gevaert P and De Sutter A. Uncertainties: What treatments are effective for common cold in adults and children? BMJ 2018;363:k3786. DOI:10.1136/bmj. k3786

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