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Tuesday, Oct. 23 at Noon ET

Children and Cold Medication

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Dr. Ian Paul
Pediatrician, Penn State Children's Hospital
Tuesday, October 23, 2007; 12:00 PM

Is it safe to give your toddler something for the sniffles? Dr. Ian Paul was online Tuesday, Oct. 23 at noon ET to offer advice and analysis about recent FDA warnings that cold medication may not be safe for young children.

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A transcript follows.

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Martinsburg, W.V.: Can I still give my 7-year-old daughter 1 and 1/2 teaspoon of Triaminic? She never had problem with Triaminic. It's still safe taking Triaminic?

Dr. Ian Paul: There have been no proposed changes at this point for children 6 years of age and older. Continue to closely follow instructions for children over age 6.

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Upper Marlboro, Md.: Does this also apply to pediatric forms of Tylenol and Motrin?

Dr. Ian Paul: single ingredient Tylenol and Motrin are safe to use for children

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Cheverly, Md.: When we had our first child, our pediatrician gave us a detailed copy of the prescribed doses for most of the children's over the counter medicines on the market. It gave us a solid reference guide before we gave out the medicine. Wouldn't similar information help in this circumstance? The infant drops were really deceptive advertising, being that the back typically did not provide dosages for under 2 or 3.

Dr. Ian Paul: The problem is that these doses are not based on good evidence. They were made up from adult doses and are imprecise. The current dosing has assumed that children 12 and over should get an adult dose, children 6-11 should get half of an adult dose, and children 2-5 should get a quarter of an adult dose. This is too imprecise based on today's standards of dosing medicine for children.

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Silver Spring, Md.:

I like the liquid meds because you can short the dosage (I'm a small adult) more easily.

So my concern is will they be taking all the liquid colds meds off the market?

Dr. Ian Paul: Since many of the adult formulations are in liquid form, I'd be surprised if they were taken off of the market. Much of the effect of these medicines comes from the fact that they are thick, syrup-like liquids that coat the back of the throat and calm the area that triggers coughing. This is why liquid placebos do as well as the medicines when they are compared in a research study.

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Arlington, Va.: How did this happen in the first place, that these medications went unregulated for kids for so long?

Dr. Ian Paul: The standards for research have changed. In the 1960s, it was considered unethical to do research with children for medicines. Today, the opposite is true. Therefore, the medicines didn't undergo the same scrutiny that we see today. It has taken a long time for people, including myself, to actually test these medicines and for the reports of side effects to make it into the public's awareness.

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Washington, D.C.: What should we do for kids under 6 who have colds or the flu? Rest, vitamins, fluids?

Dr. Ian Paul: First, I completely sympathize with parents that it is really tough to watch kids suffer with these symptoms without much to do for them. New research will definitely be happening to hopefully get parents some solutions in the near future. In the meantime, I recommend: 1) acetaminophen (Tylenol, etc.) or ibuprofen (Advil, Motrin, etc.) to help improve comfort, 2) saline (salt water) nose drops or nose spray, 3) warm, humidified air, and 4) plenty of fluids.

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Alexandria, Va.: What exactly can happen to children who take cold medicine? Are there specific problems likely to occur, or is it just a blanket warning because of a lack of research?

Dr. Ian Paul: In general, with small doses of the medicines, there can be mild side effects. We are talking about many kinds of medicines here, but some examples would be hyperactivity, sedation, abnormal muscle/limb movements, etc. For children with heart conditions (diagnosed or undiagnosed), some of the medicines can interfere with the heart rhythm. With overdoses, severe side effects and even death can occur, though this has fortunately been quite rare.

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Silver Spring, Md.: I have an 18 month old. Her pediatrician said not to give cold medicines until she was at least a year old. Two months ago she got a terrible summer cold, and her pediatrician said it was okay to give her some infant cold medicine. We followed his dosage recommendation, and it definitely helped her. Before taking it, she was miserable and cranky because she couldn't breath very well due to a stuffy nose. After taking it, she could breath better and seemed her normal happy self. So why do they think it isn't effective for children under 6? Also, why would it not work for children under 6, then suddenly be effective for anyone over 6? That doesn't make sense to me.

Dr. Ian Paul: Great questions. It is possible that some of these ingredients may help some children, but current research either a) shows the medicines to be no better than a placebo or b) doesn't provide good evidence on what dose to use. Your pediatrician was guessing on a dose, something most of us aren't comfortable doing. Because we all get better from every cold, often it seems that the medicines are working because of the nature of the illness -- it gets better.

For your 2nd question -- they do not suddenly become effective over age 6, and I don't believe most of these medicines are better than a placebo for children over age 6. However, bigger children and adults are less vulnerable to the side effects of the medicines, which is why the FDA advisory committee voted the way they did.

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washingtonpost.com: Thank you Dr. Paul for taking questions today.

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Editor's Note: washingtonpost.com moderators retain editorial control over Discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. washingtonpost.com is not responsible for any content posted by third parties.


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