Colds, coughs and what to give

The medicine aisle offers a great deal for childhood colds, most of which is either ineffective or not recommended for young children.

What is not recommended

Over-the-counter cough and cold medicines are advised against for children under six years in many countries, and used with caution up to twelve.

The reasons: lack of evidence of benefit, and reports of harm including from accidental overdose.

This includes decongestants, antihistamines marketed for colds, cough suppressants and expectorants.

Codeine is contraindicated in children for cough and in specific circumstances after surgery, because of unpredictable metabolism.

Aspirin should not be given to children because of the association with Reye's syndrome.

And combination products are particularly risky because they contain paracetamol or ibuprofen alongside other ingredients, making accidental double-dosing easy.

What does help

Simple and effective.

Fluids, offered frequently in small amounts.

Paracetamol or ibuprofen for fever or discomfort, at the correct dose for weight and age.

Saline drops and gentle suction to clear a blocked nose before feeds in babies, which is genuinely useful since infants breathe through the nose.

Honey for cough in children over twelve months, which has trial evidence comparable to or better than over-the-counter preparations, and which must not be given under a year because of infant botulism risk.

A humidified or steamy environment, where the evidence is weak and the practice is harmless if scald risks are avoided.

Keeping the child comfortable and upright for sleep in older children.

And time, which is the main treatment.

Dosing safely

Where errors are common and consequential.

Dose by weight and age according to the product instructions, not by guesswork.

Use the syringe or spoon provided, since kitchen spoons vary substantially.

Check the concentration, since infant and child suspensions differ and using the wrong one causes overdose.

Do not exceed the stated number of doses in twenty-four hours.

Keep a written record of what was given and when, particularly where more than one adult is caring for the child.

Do not give paracetamol and ibuprofen together routinely — guidance advises using one, and considering the other only if the child remains distressed.

And check whether any other product being given already contains the same ingredient.

Ibuprofen specifically

A few cautions.

Give with or after food.

Avoid in children with asthma who are known to react to it, and in dehydration, since it can affect kidney function.

Generally avoided in chickenpox because of a possible association with skin complications.

And not used in infants below a specified age or weight.

Antibiotics

Worth restating.

Colds, most sore throats, most coughs and most ear infections are viral or self-limiting, and antibiotics do not shorten them.

Green nasal discharge does not indicate bacterial infection.

A clinician declining to prescribe is following evidence, and a delayed prescription — to be used only if things do not improve — is a common and reasonable approach.

Where antibiotics are prescribed, the course should be taken as directed, and leftover antibiotics should never be kept or given to another child.

Storing medicines

A safety point that matters more than it appears.

Keep all medicines locked or well out of reach, including in handbags and at other people's houses.

Use child-resistant containers, which are resistant rather than proof.

Do not describe medicine as sweets.

Check expiry dates.

Dispose of unused medicines at a pharmacy rather than in the bin.

And know the number for your national poisons service, since paracetamol overdose in particular is serious and treatable if identified early.

When to seek help rather than treat

The features that change the picture.

Any fever in a baby under three months.

Difficulty breathing, rapid breathing, grunting or drawing in below the ribs.

Poor feeding, or significantly reduced wet nappies.

Drowsiness, floppiness or difficulty waking.

A rash that does not fade under pressure.

A cough lasting more than three weeks, or with weight loss or night sweats.

A barking cough with noisy breathing in, which may be croup and is treatable with steroids.

Coughing fits with vomiting or colour change, which may be whooping cough.

And any deterioration, or any parental sense that this is different from previous illnesses.

General information only, not medical advice. Follow product dosing instructions exactly, do not give over-the-counter cough and cold medicines to young children, and seek urgent care for breathing difficulty or an unwell baby.