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Runny Nose and Cough …. Allergy or Cold

NOTICE: The AAP and FDA have made a recommendation that cold medications are not to be given to Children below 4 years old.  Deaths have occurred mainly from over doses and usually with the concentrated form of cold medications.  If dosed correctly and used sparingly, I think the risk is very rare so I will allow these medications past 2 years old.  You need to be warned however and the advice on this page should be used if you know the risks.  I frequently talk parents out of giving medicine but if you are going to give something to your child, then here is the advice I have given for many years.

See:  AMERICAN ACADEMY OF PEDIATRICS: Use of Cough Remedies in Children

The difference between a viral cold and an allergy is length of time. A cold is a runny nose &/or cough that lasts for a few weeks, and an allergy lasts for a month or more. Give a cough/cold medication for the symptoms. These medications do not cure the problem, nor prevent complications like ear infections, bronchitis, pneumonia. All these medications do is slow down the symptoms "so you can rest medicine". They decrease cough, congestion, and mucus for the 4, 6, or 12 hours but if you are going to have a cold/allergy for a month, then you will have it for a month. The medicine does not make it go away quicker. So there are a series of questions you have to ask when talking about treating the cold/allergy. Is it bothering the child or the parent? If the runny nose or cough is not bothering the child, we would just as soon not treat the symptoms and just wipe their nose. (How do you make a Kleenex dance? You put a little boogy in it.:) I would rather they be alert and learning, instead of drowsy on the antihistamines. If the cold is bothering the child, then the next question is which medication. A certain medication may help this child but not that one. And that medication may make this child drowsy and that child hyper and not sleep. So everyone is different in how they react. We cannot tell you the best one for any certain child or adult. It is a trial and error. If the mother down the street brags about her medication and how it helps her child, borrow a teaspoon and see if it helps your child. Treat only when the child has the symptoms. You may only have to treat it at night. You also can sleep the child with the head elevated; especially the infants can sleep in their carriers, swings, or car seats all night. Another old fashion way is to put Vicks Vapor Rub on their feet (yes feet) and put socks on them.  That helps the cough.

Lets talk about the ingredients of medications. There is only one decongestant over the counter and that is "Sudafed". Sudaphedrine or Ephedrine is "Sudafed". This is the decongestant in all preparations. There is only one cough suppressant and that is Dextromethorphan (DM). I do not think that expectorants are useful and they taste terrible. So the only difference in most of the medications is the antihistamine that dries up the mucus. Look for a medication that is for cough (dextromethorphan), and stuffy nose (Ephedrine), and runny nose medicine (these other medications will be the antihistamines). If it covers all the symptoms, then you can use it for most illnesses. There is Triaminic, Pediacare, Tylenol Cough and Cold, Dimetapp, Claritin, or generic drug store brand and many others. It still boils down as to which one will help your child. Then there are prescription ones that are different but are not stronger. Claritin was prescription and now over the counter but it only helped 50% of the children.  Prescription ones tend to be newer on the market and the company has a "copy right".  Then after so many years the product goes over the counter and generics come out.  There is Zyrtec and Allegra and others that are now non-prescription meds. These are long acting antihistamines that last 12 to 24 hours. You can give a decongestant Sudafed with them ( or get Claritin-D which has the Sudafed in it). But these will not help the cough most of the time and they are for allergies and not colds.  You can try Vicks vapor rub on your child's feet and put a sock on it.  This helps better than on the chest and can be used starting around 6-9 months of age. If the cough is severe at night and none of the cough medications like Nyquil or Vicks 44 are helping, then call for prescription cough medication that has Hydrocodone  and it will help decrease the cough so everyone can sleep.  This stronger cough medication should be used sparingly and only for the night cough and for children school age and older.

Most of the over the counter cough meds are dosed the same.  Get the cough/cold medicines that are liquid for children (not concentrated eye dropper form) and dose it:
for 22-33 lb., give 1/2 the dose listed for the 6 yr old.
for 33-44 lb., give 3/4 the dose listed for the 6 yr old. 
for over 44 lb. give the dose listed for the 6 yr old.

The AAP does not recommend cold meds below 4 years old.   Definitely not use them below 2 yr old.  The main problem is the decongestant like sudafed.
Decongestants like sudafed should not be used for children below 2 yr old.  Use a pure cough medication with dextromethorphan like Delsym (use 1ml dose for 18mo to 4 yr.)

For allergy congestion, there are nose sprays of steroids and they are safe. You have to use them all the time and not just when you are symptomatic. Discuss them with the doctor if you are not helped out by the oral medications.

The cough can sound deep and congested, but if the child is happy, playful, and has no fever, then treat the cold as above. If the child has fever 101 rectal or more, is lying on the couch not playing, is screaming several times at night, or has continuous green mucous runny nose plus irritable all day, then make an appointment. One cannot tell it is bronchitis by the sound of the cough. If the child gets pneumonia or bronchitis, the cough will sound the same and the child will start having fever and lay around after the 5th day of the cold. So watch how the child acts, not go by the cough.

If the cough makes a seal-bark honk sound, it is "croup". It is helped by a vaporizer, or take them into the bathroom and steam it up like the London fog, or actually put them in the car and drive around in the cool night air. It treats the strider (respiratory distress). If they are in severe respiratory distress, then go to the ER. If they do OK for the night, then see your doctor for a short course of steroids to open up the airway and keep them out of the Hospital. See them in the AM even though they are better for it is more severe on the second and third nights.

Coughs that are severe and they cough 10 times without breathing, and cause them to gag and even throw up, should be seen by the doctor.

Allergy testing and shots are generally not recommended till 4 yr. or older and then I am still not crazy about them unless there is asthma. The night only cough is usually allergy. To see if it is anything in the bedroom causing it, sleep the child out of the bedroom or out of the entire house at Grandmas or neighbors. The child will be fine that night and the next morning. Then it is something in the bedroom or house (pillow, mattress, stuffed animals, cat, dog, smoking, etc.)

Remember to ask yourself:  "Who are these symptoms bothering, you or the kid?"

Dr. Knapp