Decongestant safety unclear in kids

RTIs - girl blowing her nose

An Australian researcher has urged health professionals not to give decongestants to children under the age of 12

Not only do these treatments fail to alleviate cold symptoms but their safety is unclear, says University of Queensland Primary Care Clinical Unit Head Professor Mieke van Driel.

A new study conducted by Dr van Driel, pharmacist and PhD student Sophie Scheire, postdoctoral researcher Laura Deckx, and professors Philippe Gevaert and An De Sutter analysed published findings about the effectiveness of common cold treatment among children and adults.

“For adults, the evidence suggested that using decongestants alone, or with antihistamines or analgesics, for a maximum of three to seven days could alleviate nasal symptoms,” Dr van Driel said.

“But for children, these medications had no effect on nasal symptoms.

“We recommend they should not be given to children under six and advise caution between six and 12 years of age due to potential adverse effects such as drowsiness or stomach upset.

“In children under two, they have been associated with convulsions, rapid heart rate and death.”

Dr van Driel said doctors should instead reassure young patients and their parents that while having a cold is distressing, symptoms should pass in a few days.

“If parents are concerned about their child’s comfort, saline nasal irrigations or drops can be used safely.

“But based on currently available evidence, reassurance that symptoms clear within seven to 10 days is the best you can offer these patients.”

The researchers looked through the Cochrane Library to find systematic reviews that investigated the effectiveness of treatments for the common cold.

If only a protocol or no Cochrane review was available, they searched PubMed for other systematic reviews on the topic.

If no systematic reviews were found, they looked for individual randomised controlled trials of commonly used treatments.

The researchers then extracted data on the subjective severity and duration of nasal symptoms (nasal congestion, rhinorrhoea, and sneezing) and adverse events and extracted the number of studies and participants, and where available, used pooled results.

If pooled results were not available, they assessed whether the findings were in favour of the active treatment.

“The Cochrane review on combination treatments for common cold reported that a combination of acetaminophen decongestant antihistamine in children improved nasal congestion on day five (although not on day 3) compared with acetaminophen alone.

“An NSAID decongestant combination reduced the duration of nasal congestion compared with pseudoephedrine or placebo. Antihistamine-decongestant combinations did not show consistent effects on nasal symptoms.

“Saline nasal irrigation may improve nasal congestion in older children and possibly reduce rhinorrhoea severity. Vapour rub may improve nasal congestion (not rhinorrhoea), but at an increased risk of adverse events.”

The researchers also did not find evidence to support the use of other common treatments and home remedies in children (such as heated humidified air or steam, analgesics, echinacea, probiotics, herbs, or vitamins).

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