Cough and Cold Management in Children Under Six

Written by Victoria Ip, BScPhm, RPh, CGP

The days are getting shorter, the leaves are changing colour, and we’re starting to feel that chill in the air.  It also means that cough and cold season is just around the corner. Although there is no “cure” for the common cold, many over-the-counter preparations are available to help relieve symptoms. However, these are not suitable for use in children under the age of six because they have not been proven to be effective, and in fact, can be potentially harmful in this patient population. So, what can we, as pharmacists, do when parents come in asking how they can help their sick child?

Explain the rationale behind not using cough and cold medications (CCMs)

Health Canada released a statement in 2008 advising against the use of CCMs in children under the age of six, and that all CCM products with dosing information for children under six years old be removed from the Canadian market by fall 2009.  Many parents and caregivers may have grown up taking these medications and thus, are not aware of or do not understand the recent changes. As pharmacists, we need to explain that when these products were first approved, there was no data on their safety and efficacy in the pediatric population. Furthermore, recent reviews have not shown CCMs to be effective and in fact, their use may lead to serious harm such as misuse, overdose, and side effects.

Provide alternatives for managing symptoms

The best way to get rid of the cold is to ensure the child gets plenty of rest and drinks lots of fluids. Providing options for symptom management may also help the child feel more comfortable; these include:

  • For fever/aches/pains – Acetaminophen (for children >3 months old) or ibuprofen (for children >6 months old) can be used to relieve discomfort. Avoid aspirin due to concerns of Reye syndrome.
  • For nasal symptoms – Supportive treatments such as adequate oral hydration; saline nasal drops, sprays or irrigations; nasal suction; and cool mist humidifiers can be suggested.
  • For cough – Oral hydration, warm fluids (e.g. chicken soup), and room humidifiers may help. Honey (2.5-5 mL either given straight or diluted in liquids) is also an option for children ≥1 year of age.

Although menthol and camphor rubs are generally not recommended for nasal congestion or cough in children with the common cold, the use of these products has been associated with increased patient perception of superior relief when used for nocturnal congestion, cough, and sleep difficulties in children. To prevent respiratory distress, medicated rubs should never be applied directly under or into the nostrils. These products should always be used with caution as ingestion of even small amounts can be toxic to children and should not be used in children under two years of age.

Inform parents that other cough and cold treatments such as echinacea, zinc, and vitamin C have also not shown benefit in the pediatric population and are therefore not recommended for use.

Advise on when to see a doctor

If the parents have any general concerns or worries about the child, a physician should be consulted. Some other situations in which the parents should contact their doctor include:

  • If the child’s symptoms worsen or do not go away in 6-10 days
  • Fever in children <6 months old or fever for >3 days or temperature >38.6°C in children >6 months old
  • Serious symptoms such as behaviour changes (e.g. irritability or lethargy); persistent vomiting; or signs of difficulty breathing, breathing rapidly, or working hard to breathe
  • Child is refusing to drink for long periods of time
  • Eyes that are red or have a yellow discharge
  • Signs and symptoms of an ear infection (e.g. fussiness, ear pulling, or pain)

Provide empathy

Having a sick child can be very stressful for parents. Pharmacists can help by providing reassurance of the self-limiting nature of colds and recommendations on how to manage cough and cold symptoms in children under six.


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