Managing Colds, Cough, and Fever in Children

Pediatric patients often suffer from viral upper respiratory infections (“the common cold”)with symptoms including congestion, rhinorrhea (runny nose), cough and, occasionally, fever. Children experience approximately 3 to 8 colds each year, about twice as many as adults. The annual cost of colds and cold-like illnesses in the US is an estimated $40 billion – due to lost work days for parents, medical appointments, and the cost of medications. Cough, a common symptom of several childhood illnesses, is the second most common reason for emergency department visits by children aged 15 years and younger.

Another common symptom among children, fever, accounts for an estimated 6% of all office visits to pediatricians. Typically, colds and related symptoms of cough and fever are self-limiting, but nondrug measures and over-the-counter (OTC) medications may be used to relieve bothersome symptoms. Although many OTC medications are recognized as safe and effective through the FDA’s OTC monograph process, clinical trial evidence to support their use in children is limited.

In 2001, concern began to escalate about serious adverse effects and deaths related to cough and cold medication use in infants and young children. In addition, adverse events related to cough and cold medications were implicated as a common reason for emergency department visits, especially among young children. These reports led to a 2008 Public Health Advisory from the FDA recommending that cough and cold products not be used in infants and children under the age of 2 years. Following this recommendation, manufacturers voluntarily updated the cough and cold product labels to advise against use in children younger than 4 years.

Pharmacists and other easily accessible healthcare providers are key sources of information about the drug and nondrug options for treating colds, cough and fever in children. Placing emphasis on nondrug options is important to avoid unnecessary medication use and potential side effects. When OTC medication is recommended, caregivers need advice about identifying and measuring the correct dose (which can be quite confusing) as well as any contraindications or side effects of concern for the individual child. This issue focuses on OTC options for cold symptom management; prescription medications (eg, ipratropium nasal solution for rhinorrhea) are not included.